Premature Aging

How old is she really?

According to our veterinary records (based on exams when she was first adopted in 2007), Elly's estimated date of birth is May 2006, which pegs her at six-and-a-half years old. Her body, however, seems to think it's much older than that. I offer as evidence:

• gum disease and dental decay (feline stomatitis)
• bone spurs (arthritic hips and spine)
• kidney failure

Poor thing. 

I sympathize with her. 

A year ago, I remarked that I felt I was "time expired." That post was well before I realized my diabetes was out of control and that migraines would become a routine event. Before I turned 50.

Which brings us to last week: I went for CT scan to see if my frequent migraines were a harbinger of something more sinister, like strokes or a tumour [gasp!] pressing on the optic nerve. [What? Are you saying you wouldn't have googled it?]

Imagine my surprise when my doctor's office called me on Monday and said the doctor wanted to go over the results of said scan with me. 

Bad news. It is never, ever a good thing when the doctor wants to see you, rather than the other way around.

Short story: I'm old.

Long story: the CT scan showed "micro-vascular changes." The blood vessels in my brain are on a weight-loss diet, which would be great, except that it means they aren't able to carry so much oxygen to the brain. My doctor, who is in her early thirties, said, "We wouldn't expect to see this kind of thing until you're about 70."

Seventy? 

She went on to say that this is likely because of my diabetes, which causes all sorts of systemic failure . . . in the heart, the kidneys, the nerves, the retinas. Especially if said diabetes is uncontrolled, as mine was for about a year. 

A year, folks, not a decade. And I've been quite conscientious about taking care of myself (as long as, you know, exercise isn't involved ).

The doctor says no follow-up is required, in the way of testing. But you know, and I know, that the only way to increase vascularization (blood flow) is exercise. It would appear that I have a 20-year deficit. Damn. I may have to start taking the bus to work. 

The New Doctor

We moved back to Canada from Colorado on July 1, 2010. I've been looking for a regular family doctor ever since then. I had no idea how difficult it would be.

For a while, I went back to my next-to-last doctor in Ottawa, but was increasingly dissatisfied there. Then I got lazy and just went to walk-in clinics. And then my blood sugar went sky high because my diabetes was unmedicated and completely out of control.

At that point, my search for a family doctor became a little desperate.

Then, one day, a friend bumped into her friend, who happens to be a family doctor here in Ottawa. That friend mentioned that her practice had just taken on two more doctors and was accepting patients. Happy dance! Woop! Woop!

[Side note: I had registered with the Ontario Ministry of Health's database to help people find new doctors. They somehow were unaware that this practice was accepting patients. Sad.]

Within minutes, I called the office and made an appointment to meet one of the new doctors. Today was the big day.

I liked the practice right away: the front-desk staff were friendly, but businesslike. They didn't keep me waiting for more than 15 minutes (during which time I filled in paperwork).

The doctor herself was both friendly and professional. She was also frank about a few things that she thought might be issues for me:


1. They prefer that their patients not go to the many, many walk-in clinics in the city. This is because when they take me on as a patient, the Ontario Ministry of Health pays the practice a flat stipend for routine medical appointments. If I go to a walk-in, the charge for that visit is deducted from my doctor's stipend.

This is my preferred approach anyway - I would rather see my regular doctor than a stranger! (I haven't had great luck with walk-in-clinic doctors and I loath the amount of time wasted waiting.) 

2. In order to support this approach, they have a system called "Better Access." Although some appointments can be booked in advance, most, including routine follow-ups, are only booked 1-2 days ahead. This allows for more impromptu visits.

This also suits me fine. It can be difficult to plan my schedule more than a week ahead anyway. On the other hand, she does consider stabilizing my diabetes a high priority and allowed me to break the last-minute-booking rule and make a follow-up appointment in September.

3. They also have long hours and their own after-hours on-call doctor. This helps cut down on the need to go to a walk-in or emergency.

Sure wish I'd had access to this care when I spent hours in emergency for chest/neck pain. They might have made the same recommendation (my symptoms were ambiguous), but it still would have been better to have some follow-up.

4. She has only prescribed Victoza for patients who have received their initial prescription from an endocrinologist, so she is not an expert at all. 

Neither was the walk-in doctor who prescribed a medication on top of the Victoza that threw me into hypoglycemia. It's not ideal, but she's aware of this gap in her experience. And, unlike with the walk-in doc, I  can call the office immediately, rather than waiting a week.


5. They are pretty conservative about ordering tests and lab work.

But she does like to establish some baselines, so she ordered some fasting blood tests right off the bat.

6. She is not accepting any new patients.

But, she will take anyone from my family, including Steve when he retires from the military in two years. She will also take Brian.

All in all, I am one very happy woman.

Bonus: My new doctor's office is about a five-minute drive from home and about 20 minutes from work, so not bad.  

How to say "no" to a customer.

This is another non-rant. Sort of. I do complain, but mostly, I want to point out a retail practice that makes for good business.

The blood-testing apparatus.

It will come as no surprise that the supplies for my diabetes care are covered by our supplemental health insurance. It also won't surprise you that the little strips that are used every time I test my blood sugar cost just shy of a dollar apiece. I test my blood about 3-6 times a day.

That adds up to almost $200 per month.

Recently I had some confusion about how those strips could be billed directly to my insurance, with me only having to pay the co-pay.

Here's what I experienced at two different pharmacies, and why I will hereafter shop at Pharmacy #2.



Pharmacy #1 - near where I work
Despite my printout of a message from my insurance that stated that a doctor's prescription was not required, the pharmacist insisted that he would need one. He asked me to wait while he called the insurer. Not surprisingly, this took a long time and it ended inconclusively. He got off the phone and said he would have to follow up with the insurance company's main office. I left feeling frustrated and with little confidence that the pharmacist would actually follow up. In any case, he had made no effort to gather my contact information.

Pharmacy #2 - near where I live
Also insisted that she was unable to submit a claim without a doctor's written prescription. However, she asked if she could keep a photocopy of my message and call the insurance company later. The following day, I got a call from the pharmacy asking if it was okay for them to fax the insurance company a copy of my message. (Yes, it is odd that the insurance company couldn't get that information more directly, but health information has all sorts of reasonable access controls around it.) I agreed. About an hour later, the pharmacy called me back and explained that the agent had given me incorrect information: I did indeed need a written prescription.

While that won't happen until I have a regular appointment with my new doctor (in late August), I so appreciated the second pharmacy's courteous approach and respect for my time that I will continue to buy my prescriptions and supplies there.

Both suppliers had to tell me they were unable to fulfill my request, but the way in which they did it left me feeling completely different. And that is worth paying for.

Operation Family Doc

The military member
of whom I am so proud.

Good news! The Canadian Military Family Resource Centre in Ottawa has started a program to help support families like ours who don't have a family doctor. (Note to my American friends: in Canada, because we have universal health care, military dependents are not eligible to use military health services.)

We received a mailing yesterday about "Operation Family Doc," which said, in part:

What is “Operation Family Doc”? 
This program facilitates the families of Canadian Forces (CF) members to obtain a family physician in a timely manner.  

Why is this program needed? 
CF families, because of frequent moves to accompany the serving member throughout his or her career, find it difficult to find and maintain family physicians. The average posting is 3 to 4 years, during which time the family may not find a regular physician and may have to rely on drop-in clinics or hospital emergency rooms. Operation Family Doc aims to link families with their new doctor as soon as they arrive at their new post. 

Amen. It's about time.

The member does have to submit an "application," and it isn't clear how long it will take to connect a member's family with a doctor, but it most certainly has to be less than two years, which is what it's taken me.

This, coincidentally, comes about six weeks after I sent a letter to the Director General of Personnel and Family Support Services (DGPFSS - cuz you juts know there is an acronym!). Here's what I wrote:

I am a proud military wife writing to let you know about an issue that you may not be aware of: access to consistent health care for families of military members upon return from an out-of-country (or even out-of-province) accompanied deployment.

The Canadian Forces has already ensured that military dependents are not subject to the usual three-month waiting period for provincial health coverage. That gave me tremendous peace of mind when returning to Canada!

I would like to see something comparable for access to a family doctor whereby a medical practice would be obliged to accept military dependents as new patients on a priority basis. I appreciate that this would require negotiation with the provincial health systems or the Canadian Medical Association, but I consider this an extremely high priority for the wellbeing of military dependents and the likelihood of military personnel to accept accompanied out-of-province or out-of-country postings.

Here is our story. I doubt that it is exceptional.

In 2005 my husband was deployed to NORAD in Colorado Springs. It was an exciting posting for our family and well worth the upheaval. 

However, upon returning to Ontario in 2010, we learned that our previous family doctor had moved to a different city. This was critical as our family has several chronic health conditions that require ongoing, consistent medical supervision: I have Type II diabetes which at the time of the move was diet-controlled and required no medication.

Furthermore, given the shortage of doctors in the province, Ontario had established a central registry whereby individuals could “register” to go on a waiting list. I did not learn about this list until more than a year after we moved to the province. 

In the meantime, I was “rejected” by several practitioners. My diabetes soared out of control and one doctor at my local walk-in clinic refused to prescribe medication. Finally, I found a walk-in doctor who would prescribe medications for my diabetes. There are more twists and turns to the story, but I’ll leave it there.

Recently, through word of mouth, I learned of two doctors who are accepting new patients. In August, I will meet my new doctor. I hope she will also take on other members of my family.

As I said, I am grateful that, despite all my difficulties, I had confirmed health coverage immediately upon setting foot in Canada. In these times of doctor shortages, I think it is appropriate to extend that assurance to include access to a dedicated family doctor.

I haven't received any reply from the DGPFSS, but I can't help wondering if my letter actually made a difference. Wouldn't that be nice? Or perhaps I'm not the only one to speak up about the issue. 


In any case, I'm pleased. Military families should absolutely not have to go through what I have.

The Lost Weekend

Don't you hate it when your weekend is just a big . . . dud?

On Saturday, I succumbed to the magnetic lure of my pillow and slept until noon. Even as I drifted back into my dreams, I knew it was a bad idea, but I did it anyway.

And then I refused to drink any coffee because that would only compound the difficulty of falling asleep at a reasonable hour ["reasonable" in this case being around midnight]. So I passed the day feeling sluggish and occasionally sighing.

But I did get to sleep around midnight.

On Sunday I ended up in the emergency room, worried that I was having a heart attack or an angina attack. [Spoiler alert: it was neither.]

My chest/neck pain started shortly after I got up and seemed to get worse as I went about my day preparing for our guests who were to arrive later Sunday afternoon.

Finally, I decided to call Telehealth Ontario (1-866-797-0000) and I spoke to a nurse. She ran through a series of questions then told me she was going to transfer me to an ambulance! Since we live only five minutes from a hospital, I told her I would rather my husband drove me in.

She made me promise that I would go to the hospital immediately. I did.

I also told Steve that, should anything dramatic happen to me, he should lay on the horn and just DRIVE.

We made it to the hospital without incident. Over the following five or six hours, I learned the following:

• Angina does not last for hours. It lasts for minutes.
• The diuretic I take to reduce my blood pressure can cause low potassium.
• Low potassium can cause muscle pain.
• The enzyme by-products of heart injury can take up to eight hours to show up in blood work.
• Chest/neck pain like mine can also be cause by GERD (reflux) or muscle spasm. (Or lung problems, but I had a clear x-ray.)

I was sent home still in pain, which seemed to have gotten worse, but at least confident that death was not imminent. 

Our visit with friends was postponed until Monday morning (which I had already taken off).

When I meet my new doctor in August, I will follow up on this. In the meantime, this weekend totally sucked lemons. I'm glad I have Monday off! 

There's just one thing that I can't figure out.

Peter Falk, scratching his head.

Remember Peter Falk’s squinty-eyed Lieutenant Columbo? 

We all waited for that moment when he would walk dejectedly away from the murderer (who would be smirking, thinking he had literally gotten away with murder), then pause, scratch his head, turn back to the guilty SOB and apologetically say something like, “There’s just one thing that I can’t figure out.”

Within seconds the tightly knitted veil of deceit would unravel and the killer would have given away the entire case.

Last week, as I left my doctor’s office, I felt like Columbo – but about three minutes slower on the draw. 

By the time I thought of the questions I wanted to ask, the doctor was on to her next patient and I was at the pharmacy dropping off new prescriptions for drugs unrelated to my questions.

A few minutes earlier, the doctor had blithely noted that my ECG results had been normal. Then we spent several minutes discussing my diabetes meds (and even my pearls!), without returning to the ECG and the reasons for ordering the test (the bizarre morning pain that scared the crap out of me).

So many questions ran through my mind:

• Does that mean it’s not angina?
• What should I do if it happens again?
• Could it have been a stroke-type thing? Or a transient ischemic attack?

All of which remain unanswered, except by the internet.

Does that mean it’s not angina?

No. Angina is not usually detected on an ECG unless it actually takes place while the electrodes are stuck to your chest. This works well with normal, activity-related angina, but not with the kind that occurs while you are resting, as I was. ECG is great for showing that there is damaged heart tissue, as is the case with a heart attack.

What should I do if it happens again?

If symptoms do not abate after 5 minutes of sitting up and resting, call 911. In my case, even if the symptoms do ease (with or without coughing), I will get myself to a clinic and ask my questions.

Could it have been a stroke? Or a transient ischemic attack?

Actually, the internet cannot answer this one. I will have to talk to an actual doctor about it.

Which brings me to the best news I’ve had in AGES: I finally have a doctor. Well, sort of. I have a meet-and-greet appointment with a doctor in August. She is in a group practice near our home and is about three years out of school. She probably looks like a teenager. 

Hitting an all-time low.

[Note: I am stranded at the Caalgary airport, delays in my flight from Ottawa having caused me to miss my connection to Saskatoon (or S'toon, as Saskatchewanianianians call it). No pictures in this post because Blogger and iPad disagree on that.]

The problem with being an "early adopter" is that you get to work out the glitches in whatever cutting-edge technology is using you as a guinea pig. My most recent experience is with the relatively new diabetes medication Victoza.

It's been available in Europe for a while, so I'm not worried about any ghastly side effects or anything (or I wouldn't try it), but I did Suffer through my doctor's lack of experience with this new drug that has garnered rave reviews for controlling blood sugar while also suppressing appetite which obviously has health benefits in terms of weight loss.

For me, the suppressed appetite has been truly eye-opening, as I mentioned in an earlier post. I'm still enjoying the effects, though the weight loss has slowed.

More importantly, my blood sugar has slowly but steadily been sliding into the normal range.

But it wasn't moving swiftly enough for my doctor, (I am the first patient she's tried Victoza with.) so she prescribed a third medication. The effect was almost immediate . . . And alarming. I took a dose with dinner and woke up feeling . . . weird. Like simething was wrong. Couldn't put my finger on it.

I wasn't nauseated. Didnt havea headache or feel the hands of the grim reaper around my neck.

I finally got out of bed and realized I was a little shaky and my legs felt like rubber. That's when hypoglycemia occurred to me.

3.5 mmol/L. Hypoglycemia is anything below 4. WhAt's more, if your blood augar has been high for a long time, you can feel hypoglycemic even at higher measures.

Hypoglycemia is a medical emergency: if the muscles and brain are deprived of energy for long enough you can slip into a coma and even die.

Because of this, the body has a built-in panic response. Adrenalin floods your system.

So on top of feeling wobbly as I stumbled downstairs to find my sugar pills, I was panicky and couldn't think straight. I had planned to go for the ECG the doc had ordered (more about that later), but couldn't figure out what to do first: get dressed? Make the bed? What about my hair? Make up?

Even after my blood sugar was back to normal, I felt uneasy.

Stupidly, I took another dose. The same thing happened twice more that day. And that was that.

Meanwhile, Victoza has been ever so slowly working my sugars down into the normal range. Part of that, I am convinced, is because the "normal" appetite makes it so very much easier to say no to large helpings and non-stop snacking.

And I feel great!

But I wish I were being treated by a more up-to-date doctor. Still waiting for a referral.

And now what?

Tiramisu, one of life's sweet pleasures.
When I stop wanting it, you'll know it's time to pull the plug.

This is a continuation of yesterday's post wherein I describe my angina attack.


First, thank you for your many caring comments. I have to share a very funny one sent by e-mail from a friend who has experience with heart attacks: "BTW diagnosing yourself from the internet is not what I would describe as the most intelligent thing to do. When you decide to operate on yourself let me know. I will sell tickets."

The yet-to-be-confirmed-by-a-doctor angina attack was a dramatic announcement of my mortality. I pictured the Grim Reaper at the foot of the bed, gesturing a strangulation posture, like Darth Vader.

Throughout the day, I pondered. Maybe a little obsessively.

I don't want to die. I like my life and want to keep living and enjoying it. I want to see my children's weddings, I want to know my grandchildren. I want to relish the beauty of God's world and capture it in my photographs. I want to travel with Stephen. I want to eat tiramisu.

But . . .

• I don't want to live in pain or with disability. 
• I don't want to go blind or lose my toes. (I happen to have very cute feet, thank you.)
• I don't want to give up the things that give me pleasure (yes, I'm thinking about tiramisu). 
• I don't want heart surgery (or a stent or angioplasty or any of those invasive treatments). "Don't want" is really not a strong enough expression for how I feel about this. I am deeply, deeply averse to this.
• Frankly (and I know many of you will be aghast at this), I honestly don't want to exercise, at least not to the degree that would have a significant effect on my health. (A gentle stroll three times a week is not enough to benefit cardiac health, though it is good for my mental health. Most studies and recommendations are for 30-60 minutes of brisk activity every day.)

Steve and I had a difficult talk when I told him these last two points.

He would, of course, like me to be aggressive with my illness and make every effort humanly possible to live a long, happy, healthy life. But he can understand my not wanting to be cut open or pierced.

As for exercise, "You just need to find something you enjoy," he urged. I suppose this could still happen, and if it does, then "Yay!" but even when I've had months of sustained exercise in my daily routine it NEVER became something I enjoyed. I never got those endorphins, never looked forward to it or missed it when I couldn't walk/jog/use the elliptical. Perhaps all those neuroreceptors were occupied with sustaining my overactive appetite?

My point is: I know that I am making a choice and that it has negative effect on my very life. It is selfish, and I am sorry, but there it is. (My inner voice is yelling, "Exercise? You can't make me!" I am stomping my pretty, little foot.)

We agreed that I would, however:

• Follow up with my doctor.
• Take or adjust any medications prescribed.
• Continue to reduce the amount of carbohydrates in my diet with the goal of maintaining my blood sugar.
• Continue to eat smaller portions with the goal of losing weight.

And then we talked about my dad, who died of heart disease a year (almost to the day) of his compulsory retirement at age 65. More about that in my next post.

Constant Craving

About five years ago, tired of my continual struggle to lose weight and, more frustratingly, maintain my weight loss, I screwed up my courage and asked my doctor about prescribing an appetite suppressant. He brushed me off with a comment that those medications were really meant for people with more serious weight problems than my own and concluded, "You'd have to take the pills for the rest of your life."

I already had an antidepressant on my "take for the rest of your life" list, and didn't want to add more, so I left it at that.

A couple of years later, the same doctor diagnosed me with diabetes and prescribed the first of five medications I now take for diabetes (and potential complications) every single day.

I call that a failure in preventive medicine.

Source

Later, another doctor recommended the Appetite Awareness Workbook. While the book did not help me lose weight, it did help me understand what I was struggling with.

Hunger and appetite are NOT the same thing. People who do not struggle with an overactive appetite may not realize the distinction. Wikipedia sums it up nicely:

Hunger is a sensation experienced when one feels the physiological need to eat food. . .  Appetite is another sensation experienced with eating, however, it differs from hunger; it is the desire to eat food without a physiological need. 

I know people who really don't "feel like eating,"  even when they are hungry - until you place something appetizing in front of them. My husband and sons are among them.

I, on the other hand, rarely felt actual hunger pangs because, in response to my constant craving for food, I ate about every two hours.

And I can finish a multi-course, festive dinner and, half an hour later, find myself rummaging through the cupboard for a little smackerel of something, as Winnie-the-Pooh would say. (He shares my overactive appetite.) I can be moaning with nausea and STILL want to eat something!

It is. Whacked. Up.

But something happened recently that has pulled the reins on this out-of-control horse.

I mentioned earlier that I'd noted a connection between eating a high-carbohydrate breakfast and then feeling "hungry" all day. I misused the word; I was really talking about  appetite.

Well, I've recently -- finally! -- started on medication for my diabetes. It will likely come as no surprise to you that my appetite has diminished, especially after the doctor prescribed a recently approved injectable medication when the first medication still didn't get my blood sugar low enough. One of the so-called side effects of this new medication is appetite suppression and consequent weight loss. (Yippee!)

As my blood sugar has stabilized my appetite has decreased and my "willpower" has increased. I've had no qualms about leaving a plate half-finished, no tendency to make forays through the kitchen every half hour.

I'm going to go on a bit of a tangent here, but there is a point to it, so bear with me.

In Psych 101, our professor cautioned against flawed statistical correlations. He used a rape and ice cream example. "Suppose," he said, "statistics showed that there was an increase in stranger rapes in the summer, when there was also an increase in ice cream sales. It would be flawed to say that ice cream causes rape or that committing rape makes rapists hungry for ice cream. Researchers would look for a third, independent variable such as mild weather." It was such a ludicrous example that it stuck with me.

So here's where I come back to talking about appetite.

Suppose the correlation is not between obesity and diabetes but between appetite and both obesity and diabetes. Helping people suppress their appetites would no longer be considered a frivolous or vain concern, but would be considered a step in preventing diabetes.

What about you? What are your hunger-appetite correlations?

Finding a doctor in Ottawa is not for the faint-hearted.

In a previous post, I explained that the doctor at a walk-in clinic declined to take me on as a patient because I already had a doctor.

Likewise, Emily's doctor rejected me for almost the same reason - plus, they are a teaching clinic at a hospital and want a "well-rounded practice." I guess they have too many middle-aged diabetics on their rolls.

The good news is that, when Emily's doctor gave me the bad news, she referred me to Health Care Connect a service provided by the Ontario Ministry of Health. Right there, on the first page, it explains how to register to be referred to a doctor and - more importantly for me - how to de-register with a previous doctor. (Actually, the instructions on the site are wrong; you have to phone them in order to de-register. Your doctor cannot do this for you.)

So, I officially divorced my old doctor and signed up to be referred to a new doctor. I still don't have a doctor, but at least I'm making progress.

Meanwhile, I developed a wicked sinus infection and, despite my efforts, my blood sugar continued to fluctuate into the middle and high teens (7 mmol/L is target for diabetics).

So I took myself to a walk-in clinic, the same one, in fact, where the previous doctor had rejected my request to be her patient.

This time, I was seen by an elderly woman with a wild thatch of bright red hair. She reminded me greatly of Ruth Gordon. (She is the star of Harold and Maude, a disturbing movie if ever there was one. Even more disturbing, one of our psychologists strongly implied that I was like the refrigerator mother that Harold keeps trying to reach through his faux suicide attempts.)

Back to our story.

After she wrote the prescriptions for my sinus infection, I asked if she was accepting new patients. She said she was not. I explained my plight and she explained her reasons for only doing walk-in clinics: her husband has summers off and they wish to spend them together, travelling. I told her I would do the same in her shoes.

Then she prescribed low-dose medication for my blood sugar and told me to come back in two weeks and see her during her walk-in hours for follow-up.

So, she didn't take me on as a regular patient, but she is willing to provide some continuity of care. I'm SO relieved! Meanwhile, the hunt for a regular doctor continues.

Peter's in stitches.

YesterdayToday, Peter fell and gashed his knee, requiring three stitches. There's more to the story.

There I was, enjoying my Saturday-afternoon nap, when the phone rang. Assuming it was a telemarketer, I let Brian answer it, but it was Peter, and he sounded distraught, like he couldn't quite get his breath.

"I need you to come and get me," he got right to the point. No niceties like, "Hi Mom."

"Where are you?" I asked.

"On the Mackenzie King bridge," he answered in a very tight, barely-holding-it-together voice. (Mackenzie King is where the main buses cross through downtown.)

"What's wrong?"

"Well," he stammered a little, "I've hurt myself and the bus drivers won't let me on the bus because I'm bleeding too much." Words to make a mother's heart sing.

"Okay, Peter, I'll be there in about 20 minutes," I assured him, then I hustled to go get him. I desperately wanted more information, but I knew that now was not the time.

Peter has Asperger syndrome. I hate saying that whenever I talk about him or write about him, but it gives important context. Peter's biggest challenges are social. It's really hard to describe, and it's not just that he's geeky. (Or nerdy; I know one is supposed to be an insult and one a compliment. I don't know which is which, so please assume I mean the kind one.)

Peter works part-time cleaning the inner-city parks of alcohol, drug and prostitution paraphernalia. It is really one of the few bottom-rung jobs he could get because he is ill-suited to anything in the service industry, like checkout clerk or McDonald's prep.

He takes his job seriously, works diligently, and is proud of the contribution this makes to our community. We're proud of him, too. However, in the course of this work, he has come across the unsavory underbelly of our society: the disenfranchised, the addicted, the psychotic.

These are not happy people, not stable. Peter is justifiably afraid of them. At one point, he considered carrying a can of mace (illegal) or a knife (stupid). In the end, he decided to work within the justice system and has chosen to study forensic science.

So when he called and said he had hurt himself, I imagined that one of the homeless people had hurt him. Steve imagined that Peter had cut himself on a crack pipe or a needle.

I pictured him walking from wherever this had happened to the bus stop.

I pictured him bleeding so profusely that a bus driver rejected him. I was angry at that driver. I was angry that no one helped him.

I pictured him shuffling along. One of the interesting features of Asperger syndrome is lack of coordination; in fact, it was this that first brought him into physiotherapy and occupational therapy, which eventually led to his diagnosis.

I imagined him looking somewhat like a homeless person himself, with unkempt beard and scruffy hair, with his bags of equipment for his job slung loosely about his body. I imagined people being afraid of him.

Finally, I got to him. There were two security guards with him who flagged me over to where Peter was. His jeans were ripped at the knee and sopped in blood all around the knee, which was wrapped in a grey cloth.

The security guards told me, indicating a young man nearby, that Ahab had helped him, had given his own T-shirt to Peter to stanch the bleeding which gushed every time he bent his knee. My anger dissipated with relief.

As we drove to the hospital, Peter told me what had happened: there was no violence. He was late for work, so was running. As he tried to dodge the crowds, he decided to hop over a fire hydrant. (Hey, it always works on TV!) He fell, landing on a pipe or piece of metal. It ripped his knee.

I wasn't happy that he was hurt, but I was glad that it was simply an accident.

But I prodded him on what he could have done rather than walking to the bus, who he could have called if he hadn't been able to reach me. In his state of anxiety, he had focused on getting home the usual way. It hadn't occurred to him to call for help until he was blocked. And THAT is what I mean by social challenge: most of us would immediately reach out if there were blood running down our leg.

At the hospital, things went as slowly as expected. Because Peter is 21 years old, I was told to wait for Peter in the outer waiting area. I paused, about to mention the Asperger syndrome, but then thought better of it. He was in good hands.

But I should have stayed. Turns out the doctor had mentioned that the gushing could be related to fluid from ruptured bursa in his knee. Peter never got a final answer on this (again, the social challenge) or, if it was ruptured, whether this is a big deal or not.

But we're home. He's got painkillers in his system, and he's in bed. We'll watch it, and if anything goes wrong, we'll follow up with a regular doctor.

Letting your kids, especially your "special needs" kids, become independent is fricking difficult. I wish I trusted the world more to care for him. I wish there were more people like Ahab.

Lemme OUT!

Our family doctor has his practice in the basement of an old folks' home. I expect he is the "house doctor" for the facility and also sees outside patients.

It had been many years since we had last seen him. Since our last visit, special keypads had been placed at every door between the parking lot and the doctor's office. I guess they've had concerns about senile patients wandering off, so they've taken precautions. There are three such doors. Each of these doors has a slightly different two-digit or three-digit code. On the way into the office, the access code is written on a label pasted near the door.

Leaving is another matter.

To get through the first door, we had to backtrack to the doctor's office and read a posted sign. The second door had a small label. The third door, in the outer vestibule, had a label indicating, "To exit, press." And the code had been removed. Someone had magic-markered a number that looked like either 09 or 04. Someone else had penned in 11.

Eventually, we started doing sequential combinations 01, 02, 03, 04, 05 ... We were plugging away when someone who worked in the building stepped into the vestibule and, with no preamble, said, "It's 12."

"How on earth were we supposed to know that?!" I exclaimed with thinly veiled exasperation.

"Ask someone?"

The only people we could've asked were two locked doors away. Did they think all the patients just KNEW the release code? Guess so.

The real question is what CAN she eat.

You, my loyal readers, may recall that shortly after I started this blog, my daughter Katie wound up in the emergency room because of excrooooociating pain. [You may remember the post because it was just a wee tad bit on the melodramatic side. And I played around with font sizes as I'd seen in some other blogs. Annoying really. Sorry 'bout that.]

Anyway, she was never given a good explanation for what was wrong, largely because the urine and blood test results came back benign: no blood, no proteins. They didn't do any follow-up, like ultrasound or colonoscopy. Since then, Katie continued to have minor flare-ups and was trying to weed out which foods caused her trouble, starting with the "gall bladder diet."

Once we moved back to Ottawa, we got the ball rolling to find out what the heck was up. By this time, she had ruled out so many foods that I swear she was living on rice, peas, fruit, fish and soy milk.

Finally, she saw a medical doctor who also practices holistic medicine. (Not covered by our provincial health insurance.) She sent various samples away. The results came back today, and were quite surprising.

Katie is intolerant to:

• egg white
• gliadin
• gluten
• wheat

UPDATE: she is also intolerant to dairy. Not sure how I missed that one!

and sensitive to:

• egg yolk
• rye
• kidney beans
• mushrooms

Intolerant means she just doesn't have the enzymes to digest these foods. Sensitive means she does have the enzymes, but still isn't processing them right, but should only eat them maybe twice a week or so. Fortunately, she doesn't have any actual allergies (e.g., a histamine response), so we don't have to worry about her dropping dead from eating any of these things.

She'll just be in great pain and probably farting up a storm and hogging the bathroom.

We consider this good news, because at least now we know what we're dealing with. And Katie is happy because she can go back to eating dark chocolate, coffee and hash browns. But no lasagne or doughnuts.

The interesting thing is that when she was a toddler we thought she had a wheat "allergy" and eliminated all wheat products from her (and our) diet for about a year. She was accidentally given some wheat when she was about three, and didn't have a reaction, so we thought she'd gotten over it. It didn't occur to us that the "reaction" might take a while to build up.

So, in some ways we're back where we started, but at least we now have a really clear idea of what we're dealing with.

Why I hoard.

This, THIS is why I never get rid of stuff:

Anyone who has been watching the style pages has probably already noticed that capes are back in style.

See, I had a cape, a lovely red cape, 3/4 length, suitable for autumn weather. It was perfect back in 1987-88 when I was pregnant with Katie and had an expanding belly. And it was warm enough for Alabama's winter.

And then it went out of style and malingered in the basement closet for a few years and several moves. And then I felt guilty for dragging it around and not allowing some needier person to buy it at Goodwill and give it a new life. So I donated it.

And now? Now I want a CAAAAAPE!

Pout. I'm not getting rid of anything in my basement. I may even rent a storage locker.

Tax anxiety

Ever since I started working outside the home, I've had real anxiety attacks around doing my taxes. I'm talking about heart-pounding, lump-in-the-throat, cold-sweat anxiety.

Partly, this is because when I first started working I was a self-employed contractor, so I didn't have a standard W-2 or T4 upon which to base my income and deductions. I had to pull together my shoebox full of receipts and records, hand it all over to a tax professional and pray to God that everything was on the up & up.

My taxes are still complicated because I file in both the United States and Canada. Double the pleasure, double the fun. And, much as I'm proud of Canada's social system, especially health and education, I am not delighted when my entire U.S. tax return -- and we're talking almost $3,000 -- gets syphoned into the Canadian revenue system. And then some. Sigh. It sure would be nice to just spend some of that "found money."

Instead, I have to scan and mail all my U.S. information to an accountant in Ottawa who charges a hefty sum to calculate how much I owe the Queen.

So, although I get to stay in my wrinkly pyjamas and fluffy slippers today, it doesn't feel much like a day off because I'm doing my taxes. I just keep reminding myself how good I'll feel when the whole thing is filed and done with. Kind of like that joke about banging your head against a wall: why do it? Because it feels so good when you stop.

Done with my break; back to my head-banging now.