The Basis of Self-Esteem

(Note to the reader: the following is a completely rhetorical and philosophic post.  I have plenty of self-esteem.  I have self-esteem coming out of my ears.  I regularly have excess self-esteem drained off and donated to junior high boys preparing to call a girl for the first time.)

I've been thinking a lot lately about self-esteem and how it relates to my struggles to live in such a way as to increase the odds of a healthy future.  (Coincidentally, David Spero has a column on this very subject published just today over at Diabetes Self-Management.)  I think, perhaps, that I've spent my life holding the wrong end of the stick.  Maybe I've been telling myself that I'd earn self-affirmation when I'd lost my weight, or when I'd achieved some other goal -- and it never happens. Maybe if I could learn to give myself affirmation without preconditions, I'd then have the internal resources I need to pursue my goals more effectively.

Okay, then the question arises: what is the basis for self-esteem?  If it's not working to base that esteem on what I do, then what can I count on being able to look to for strength, even on those days when I'm really screwing up?

I like to think of myself as a pretty bright guy, and I feel good about that.  But, in my worldview, intelligence is a gift -- it's not to my moral credit, anymore than my baby blue eyes are.  I like to think that I've made good use of that gift by doing a lot of reading, attaining a good education, getting a good job that I have because of that education.  But then what can I do on those days when I make mistakes?  And, at my age, the old knife just isn't quite as sharp as it used to be: am I growing less worthwhile as I age?  That obviously won't work at all.

I'm a good and caring person - is that a solid basis for self-esteem?  Well, we're getting closer to it.  But I have bad times, too -- when I'm cranky, or judgmental, or cater too much to my creature comforts.  Do I become worthless on those occasions when I don't visit a friend in the hospital because I really want to hide under my bed?  No: I think this is still dangerous ground.

The only basis I can think of that seems to serve as a solid basis for self esteem is simply that I am.  I am human: in my worldview, I am a soul, a child of God.  I have a worth that's inherent, inalienable, and indestructible.  I have the worth that every man, woman and child has, the value that causes us to grieve when we learn of the deaths or struggles of people we know nothing of.

Of course, as I learn to place more value in that worth, that means I'm also placing more value in your worth, and my coworker's worth, and the worth of the woman in the minivan that almost runs me over, and the worth of the billions of people with whom I will never have any contact at all.  That doesn't strike me as a bad thing, either.

I am worthwhile.  Simply because I am.

Don't Give Up On Me

Posting is pretty slow right now, but I hope it won't stay that way forever.  There's a lot going on that's relevant to this blog as it's developed, but it's not by and large stuff that I want to share broadly.

I will say that my fasting BGs having been creeping up and are probably averaging around 120. 

Meme, Myself, and I

I've never built a post around a meme before.  But it's probably time I was a wee bit more self-revealing.  So,  I swiped this one from Lee Ann over at "The Butter Compartment".  (Here's her response to this.)

.
1. WERE YOU NAMED AFTER ANYONE
My first name is Robert.  My parents picked it because they liked it.  My middle name, though, is after Prince Charles of England.

2. WHEN WAS THE LAST TIME YOU CRIED?
I rarely cry in the sense of sobbing, though I might be better off.  I got pretty teary just tonight, and teared up in hurt yesterday.

3. DO YOU LIKE YOUR HANDWRITING?
My handwriting is terrible, though I don't feel badly about it, I just try to avoid making other people read it. :)

4. WHAT IS YOUR FAVORITE LUNCH MEAT?
Pressed ham.

5. DO YOU HAVE KIDS?
Nope.

6. IF YOU WERE ANOTHER PERSON WOULD YOU BE FRIENDS WITH YOU?
Well, most folks seem to like me, but I think I may be hard to get close to.

7. DO YOU USE SARCASM A LOT?
What????? Are you SERIOUS?????  (Um, yes.  Though I try not to direct it at people.)


8. DO YOU STILL HAVE YOUR TONSILS
Yes.

9. WOULD YOU BUNGEE JUMP?
No way.  I'm missing the physically adventurous gene entirely.

10. WHAT IS YOUR FAVORITE CEREAL?
Probably Honey Bunches of Oats.  Can't really do cereal anymore, and that's an easy thing to not do.

11. DO YOU UNTIE YOUR SHOES WHEN YOU TAKE THEM OFF?
No :)

12. DO YOU THINK YOU ARE STRONG?
Nope.

13. WHAT IS YOUR FAVORITE ICE CREAM?
I had a banana ice cream in New York's Chinatown that was amazing!

14. WHAT IS THE FIRST THING YOU NOTICE ABOUT PEOPLE?
Facial expression, what used to be called "countenance".

15. RED OR PINK?
Red, for most purposes.

16. WHAT IS THE LEAST FAVORITE THING ABOUT YOURSELF?
I think I'll not put the answer to that one on Teh Intertubes..

17. WHO DO YOU MISS THE MOST
That's really tough.  I guess I'll go with Dr. Seuss. :)

18. DO YOU WANT EVERYONE TO SEND THIS BACK TO YOU?
I'll be happy to see any responses, but don't intend to lay any expectations.

19. WHAT COLOR SHOES ARE YOU WEARING?
 Barefoot!

20. WHAT WAS THE LAST THING YOU ATE?
Pretzels.

21. WHAT ARE YOU LISTENING TO RIGHT NOW ?
ESPN podcasts.


22. IF YOU WHERE A CRAYON, WHAT COLOR WOULD YOU BE?
I'd be the mysterious color of the one with the label that fell off.

23. FAVORITE SMELLS?
Honeysuckle, steak

24. WHO WAS THE LAST PERSON YOU TALKED TO ON THE PHONE?
My neighbor friend.


25. DO YOU LIKE THE PERSON WHO SENT THIS TO YOU?
 I do like LeeAnn, though we've not met.

26. FAVORITE SPORTS TO WATCH?
 Baseball

27. HAIR COLOR?
Brown, now graying.

28. EYE COLOR
 Blue

29. DO YOU WEAR CONTACTS?
 No

30. FAVORITE FOOD?
 Prime rib with fresh grated horseradish.

31. SCARY MOVIES OR HAPPY ENDINGS?
 I'm not really a movie guy -- I see less than one a year on average.  But, I don't do scary at all, so I guess its the happy endings.

32. LAST MOVIE YOU WATCHED?
"Wordplay", a film about a national crossword puzzle tournament

33. WHAT COLOR SHIRT ARE YOU WEARING?
 Light blue

34. SUMMER OR WINTER?
 It used to be winter, but the cold is harder on my every year.

35. HUGS OR KISSES?
 Kisses -- I prefer the solid milk chocolate rather than the mix of white chocolate.

36. FAVORITE DESSERT?
 Oh, heavens.  Sonic sometimes has a banana cream pie shake that makes me grateful I don't live near one.

37. MOST LIKELY TO RESPOND
 No idea.

38. LEAST LIKELY TO RESPOND
 St. Thomas Aquinas.

39. WHAT BOOK ARE YOU READING NOW?
 "The Art of Getting Well" by David Spero

40.WHAT IS ON YOUR MOUSE PAD
 I don't use one at this computer.

41. WHAT DID YOU WATCH ON TV LAST NIGHT?
 Nothing.  I watch a lot of Food Network and some sports -- that's about it.

42. FAVORITE SOUND?
Off the top of my head, the opening bars of Copland's "Appalachian Spring Suite".

43. ROLLING STONES OR BEATLES?
 Beatles.

44. WHAT IS THE FARTHEST YOU HAVE BEEN FROM HOME?
 Geography is not my strong point, but it's probably San Diego.

45. DO YOU HAVE A SPECIAL TALENT?
 I've been known to do a pretty mean metaphor.

46. WHERE WERE YOU BORN?
 Ames, Iowa.

47. WHOSE ANSWERS ARE YOU LOOKING FORWARD TO GETTING BACK?
Thomas Jefferson's.  Now, that was an interesting dude.

A Cooking Fool

Both key words of the title are true: I cook, and in that context I'm a fool.

My cooking skills are pretty limited.  I can feed myself, but my growth as a cook is stunted by my strong distaste for cooking from a recipe.  Occasionally I will read one or more recipes for a dish to get the idea and then wing it.  But measuring out a quarter teaspoon of this and a half cup of that is just aggravating.

However, I'm a bit of a Food Network obsessive.  This has made me a limited cook with some funny little skillzzzzz.  For example, I recently seasoned stir-fried zucchini - as basic was it gets - with garam masala, which I'd guess most folks have never heard.  Last weekend, I made a braised cabbage with some similarities to a dish I'd seen made that morning on TV, except that I threw in a bag of fresh spinach I needed to use.  This was pretty successful.  And I would put the pickled, roasted red peppers from one batch up against anything similar I've had from a jar.

This IS relevant to diabetes: very much so, in fact.  Because the more often I can make something at home that's better than what I'd get downtown, the less often I'll eat out.  And, by and large, the food I make for myself is pretty healthy: most of the options I have downtown aren't. Better food is better for my diabetes as well as for my waistline.

I like things with a lot of flavor.  I'm learning to cook with fresh chiles, and I'm gradually learning how to use seasonings like rosemary.  (Garam masala, which I mentioned above, is an Indian seasoning blend which I'd describe as being like curry powder without the heat.)  By and large, the restaurant options I have do NOT have a lot of flavor, or at least not a lot of interesting flavor.

Also, I've been adamant about not learning to bake.  Having a pan of warm brownies perpetually a mere 30 minutes a way would NOT be pretty for me.

I do roast vegetables, though.  Don't like cauliflower?  Chop it up and roast that puppy, maybe sprinkle on a little parmesan when it's done.  Fabulous.  I learned to be a bit creative with veggies when I ate as a vegetarian for about six months a few years ago.  (If I ever get the whole diet thing figured out, I'd like to move back in that direction.  But for now, I just don't need another set of restrictions.)

Now, if you'll excuse me, I put another batch of roasted red peppers under a pickle last weekend.  I haven't sampled it yet, and I'm hoping this batch will make me stamp my feet, too!

TMI

This post is about Too Much Information.  And no, I'm not about to reveal something icky or uncomfortably personal.

Since my diagnosis with Type 2 Diabetes, I've subscribed to a number of news feeds dealing with diabetes, obesity, nutrition, and general health issues.  And it's Too Much Information.

I'm not referring to information overload, although that's certainly an issue.  While there's no way I can absorb everything that comes out of the fire hose I've hooked myself up to, but that's a familiar problem and doesn't especially bother me.  I'm referring to how much of the information I get lacks enough context to be meaningful.

Take this article from a website called "Diabetes Health", to whose RSS feed I subscribe.  "Calcium May Help You Live Longer" describes a ten-year study done with 23,000 Swedish men.  The article seems to do a nice job of describing the study and what it found.   But what it DOESN"T address is what, if anything, I ought to do about it.  The sensible answer in this case would appear to be "nothing, we don't know enough yet".  But if that's the case, why did I read it?  It's a good article, and I have no problem with it.  I just wonder if that's a good information source for me.

There's sort of a spectrum here.  At one end, you've got a preliminary study done on a small number of a specific population that can't wisely be elaborated to the general population.  At the other end is the recommendations of medical associations and government agencies, which have been studied, debated, examined from eighteen directions, and maybe politicized.  The process that produces these recommendations seems ponderous and very slow to respond to new information.  (This is probably largely as it should be.)

What I'd really like is something in the middle, an article that reports on conclusions that have reached some degree of consensus in the medical community.  Down the road, for example, there might be an article that says that a number of studies seems to indicate that kicking up the calcium intake might be a good idea, it doesn't seem to be harmful, and you should ask your doctor if this might be appropriate for you. 

Maybe I just need to unsubscribe from some feeds and newsletters.

The Gap

Sometimes it seems that my life is dominated by The Gap.  And I'm not talking about clothing stores.

Many of us, maybe all of us, sometimes experience The Gap - the gap between what we intend to do and what we actually do.  This can be seen in simple, little stuff, as when we plan to write a blog post but get caught up in a game instead.  It could occur with a healthy habit we'd like to develop but just don't consistently pull off.  Or, it could relate to something we do that we wish we didn't, one of the myriad of things falling somewhere on the spectrum from habit to addiction.


Why does The Gap occur?  Beats the feathers out of me.  In an isolated instance, it may relate to fatigue, a lapse of memory, or simply the intervention of outside events that prevent us from fulfilling our intent.  When we experience The Gap repeatedly with regards to the same intention, the explanations are harder for me to find.  The easy answer is that we must not really WANT to make that change.  This may be absolutely true.  But when we've invested months or years of efforts, prayers, and even tears into a goal, I have trouble understanding  how we could want it any more. 

(Besides, is desire really key? After all, I don't really want to go to work some days, but I seem to get there somehow! *rim shot*)

Just today, I learned about a psychological concept called "self-efficacy".  The notion, if I have this right, is that self-efficacy is the belief we have that we're able to carry out our intentions. In other words, a person with strong self-efficacy doesn't perceive The Gap, or at least not much. I'd like to read more about this: there may be clues here for me, maybe even a way to progress.  This would be a good thing.

Because, sometimes, The Gap looks more like a canyon.

The Healthiest Fat Man in Kansas City

Step one (and two, and three, and four) for health improvement in an overweight Type 2 diabetic is to lose weight.  Since I recently came to terms with that not happening to any great degree, I've been thinking about what "healthy" means in that context.  Here are some of the elements I've been pondering:

• Exercise -- exercise is critical for T2s, because it's a major way to treat insulin resistance.  But it also promotes heart and lung health, cutting disease risk and helping one feel better.
• Stretching -- flexibility helps with daily living, minimizes injury risk, and is said to help promote health as one ages.
• Good eats -- I'm not sure that I'm ever going to be able to eat in an entirely healthy way, but I can make sure that my diet contains everything it should by eating lots of fruits and vegetables, getting most of my carbs from whole grains, and the like.
• Sleep -- I'd really benefit from a more regular sleeping pattern.  I'd feel better, work better, and I've seen discussion that it might also help insulin resistance.  
• Stress control -- OK, so I might not be the calmest dude around.  Working on my stress control skills would be another way to feel better and also be another way to cut disease risk.
• "Wellness" -- I'm slowly starting to believe in this concept of "wellness" as being a broader concept than "health".  Working on improving in areas such as sociability and mood control would likely help my physical health as helping me feel better in other ways.

Man, if I pulled all that off, I really could be the healthiest fat man in Kansas City!

Accountability, and new goals

Last week, I set some goals for the week.  Here's how I did:

• 15 mins exercise each day, beyond walking to/from work -- did 4 of 7 days
• Breakfast at home each day - did 5 of 7 days
• 10 mins focused breathing each day - did 3 of 7 days
• Test bg at least daily - accomplished!
• Test blood pressure twice - accomplished!

With mixed results, I'm going to keep the same goals, modify one, and add one:

• 15 mins exercise each day, beyond walking to/from work
• Breakfast at home each day
• 15 mins focused breathing each day (this went well when I did it, so stepping up time)
• Test bg at least daily
• Test blood pressure twice
• "lights out" by 11:30 each night

Particularly with the focused breathing, just remembering to do it is a problem.  Need to figure out how to set myself useful reminders..

A Bit More Comfortable

Since my little epiphany last weekend, I find my self feeling a little more "comfortable in my own skin".  In the context of a Twitter conversation, I mentioned how overweight I really am.  (That, in truth, was hard.)  I've also replaced the smiley face (and piratical smiley face) avatars I've used on Facebook and Twitter with an actual photograph.  (That was even harder.)  While these small things are not confessions in the true sense of admitting wrongs, they have had a cleansing feeling for me.  "This is who I am, folks: there's a lot of me to love."

I'm also finding that my change in attitude seems to be helping in more tangible ways as well.  By shifting my focus to small choices, the small choices have become easier.  I've been doing quite well on my goals for this week. As Twitter friend Virtue B. suggested in tweeted comments on my post, focus on the daily stuff makes recovery from a mistake much easier: I find that I don't have that awful sense of losing hard-won gains.

Of course, it's early days yet, and attitude change can be as hard to maintain as any other kind.   But, so far, the news is good.

Yay! Yay! for the F-D-A!

The U.S. Food and Drug Administration is apparently beginning an effort to induce food producers into more honest labeling practices.  This story describes letters that recently went out to a number of major food producers expressing concern on a number of areas.  I am especially glad that they are apparently going after the practice of trumpeting claims that are technically true but mask the bad news, such as bragging about "No Trans Fat!" prominently displayed prominently on the label of a product that's high in saturated fat.


Unfortunately, the government can't make producers have a desire to honestly market their products.  So it seems likely that this will always be a cat-and-mouse game.

Weekly goals 3/7/10

With the sea change I described yesterday, I need to think about the little things I'm going to do everyday.  Here are my goals for this week:

• 15 mins exercise each day, beyond walking to/from work
• Breakfast at home each day
• 10 mins focused breathing each day
• Test bg at least daily
• Test blood pressure twice

I Can't Do It.

Sometimes, we have to refocus our goals.

When I started getting fat, Richard Nixon was President and the Watergate was just a nice hotel in Miami.  When I started getting fat, a computer took up an entire floor of a building and most people had only seen one in a movie.  When I started getting fat, Paul McCartney was just months beyond leaving the Beatles.

I made my first efforts to lose weight in high school, over thirty years ago.  (About that time, Apple Computer Company was formed by Steve Jobs and Steve Wozniak.) More than thirty years of diets, some producing some success but ultimately failing. More than thirty years of firm resolutions interrupting periods of pretending not to care. That's a long, long, time. And now, my metabolism is broken.

Friends, I can't do it.  I am unable to lose a significant amount of weight.  Depending on what chart you look at, I would need to lose in the neighborhood of 120 pounds to have a normal BMI. It's not going to happen.  Through whatever combination of genetic flaw and character flaw, I am unable to make myself slender or anything like it.

And I'm no longer going to try.

Since I can't lose weight, it's time to refocus on smaller changes.  Changes that will help me feel better in the short term, hold down my A1c (even lower it a bit), and shave down my risk for various bodily catastrophes.  Eat a little better, move a little more.  My focus will be on daily choices, not on goals.  If these choices lead to some weight loss, that's great.  But I refuse to focus on it, and refuse to set objectives.  That way be dragons.

This has not been easy to write.  I'm deeply saddened to recognize that a (nearly) lifelong goal will never be met.  But, there's something else I feel:

I feel free.

Of Suckers and Charlatans

I'm almost fifty years old.  (Is that true? Can't be! Can it?)  In that time, I've seen a lot of ideas come and go.  Some of them represented actual progress, some of them turned out to be wrong, and some of them turned out to be snake oil.

I don't think of my myself as a deeply cynical person, but I do have a fairly lively awareness that some people will tell you anything if it gets you to give them money.  I'm also very aware that the latest and greatest thing may be sincerely believed to be such by it's promoters, and it may be incomplete, oversold, or flat out wrong anyway.  In any number of ways, such an awareness may be vital to survival in our culture.

But that awareness can also make it tough to make choices about how to improve my self-care.  I've seen many, many nutritional ideas arrive on the scene, be a big deal, and then evaporate.  (How many diets do you suppose "Ladies Home Journal" has published in the last fifty years?  Gotta be well over a thousand, right?)  This is hard to shake as I evaluate options.  Is "inflammation" really a key player in various metabolic disorders, and I should be learning everything I can to reduce mine, or is it just the latest thing being used to sell books and get authors on talk shows?  On what basis do I decide?

This afternoon, I was looking at books about stress management, and couldn't bring myself to check out any of them.  As I browsed, I couldn't lay aside my awareness of the possibility that it's all nonsense long enough to make a reasonable assessment.  Whenever I read a self-help book, I am haunted by the image of the stereotypical 1970's self-help guru, weaving a lovely-looking tapestry of psychobabble, uncaring that his message is useless -- or worse.

Yes, I know, I know -- a sane person could read with an open mind, make evaluations of what seems reasonable, and experiment to determine what's actually helpful.  Such a person could try out an anti-inflammation diet and see if he or she felt better, or whether a couple of weeks of deep breathing exercises really did promote relaxation.

This is yet more proof than I am not fully sane.

Metformin: Not Everybody Has Trouble

I don't know the statistics, but Metformin is probably the most commonly prescribed medication for Type 2 diabetics.  Its main purpose is to treat insulin resistance, which is the main disease mechanism in T2, at least early on.  It is also prescribed for some T1s that experience insulin resistance in addition to failure to produce their own insulin. 

Many people who start metformin experience stomach upset, diarrhea, or other forms of gastric distress. For most folks, this goes away for away after a few days.  (I understand that there are some things people who are having trouble can do about it, but I'm not knowledgeable here.)

I was lucky, and had no problems at all.  I didn't even learn of the problems so many folks experience until I had been on it for several weeks.  (Yes, it was probably discussed in the product insert.  But shouldn't my doctor or pharmacist have said *something*?)  I have found that Metformin has caused me no gastrointestinal issues at all.  (This rather surprises me, as I've been unable to tolerate a number of other medicines for similar reasons.)  And, it does the job: my fasting readings are almost always below 120, and usually below 100 if I'm eating well and exercising.)

I've seen folks in forums that seem to believe that everybody has problems with metformin.  I don't know the percentages on this, but I CAN tell you that I had no troubles.

"Everyone's Pain is Their Own"

A number of years ago, I was with dear friends, a married couple who'd both struggled with a variety of medical problems for years, when I began to feel unwell.  I had just been diagnosed with hypertension, and though that's said to be asymptomatic, my own experience makes me wonder how true that is. I apologized to my friends for my wimphood, and the wife told me not to worry, saying "Everyone's pain is their own."

I've been thinking about that statement ever since, and I think it says something important about chronic disease.  It's just not possible to tell by a medical chart just how ill a  person feels - our bodies are just too complicated for that.  And, of course, we are much more than just our bodies -- our emotional health at the moment, our spirituality, and our attitude can all dramatically effect how "sick" our disease makes us at a given time.

This is part of why I feel it's important to do what we can to back each other up, as diabetics in the DOC and also as human beings in the world.  People don't wear "pain-ometers" that tell others how much support is needed at a given moment.  A kind word or small favor to someone who's expressed no distress at all may have been deeply needed.

 Finally, there's no reason to feel disappointed in ourselves because we're having a bad day, or week, or month.    How we feel is how we feel.  Everyone's pain is their own.