testing gravity

is the way Orville and Wilbur Wright started?


We were all about catching air today...

Monkey See...

Monkey Do...

Sam is trying to do what his "Sissy" does. However, there are just some things he should not emulate...more pics on that later!

first day...

Sam had a great 1st day...no tears, no sadness and a happy smile when I picked him up.

I listened to the kids converse at the lunch table about Sam's day:

Kate: did you play ousside today?

Sam: no, I didn't.

Kate: did you play in da gym today?

Sam; no, I didn't.

Kate: did you have choice time? (kids get to pick their activity)

Sam: yes, I did.

Kate: what did you have for snack?

Sam: teddy bears.

Kate: ohhhh!

it was so cute...

winds of change...

The seasons are changing...and I'm a little sad. It's not that I don't enjoy fall, it's the inevitable winter that follows.

It starts with the "back to school" displays at the store...then the school supply lists arrive in the mail...then the calender starts to fill up with fall obligations...and if that's not enough, the tips of the trees begin to look a little red.

On Thursday, Kate had her orientation for K-4 and her first day was last Friday. She has a wonderful teacher and several friends in her class (one of them is planning to marry her?!), but she's growing up. She's charming to talk to and I love watching her expressions and mannerisms...she's almost five! I remember her toddling around at 15 months old.

Sam had his 3-K orientation Monday and his first day is tomorrow. He was 4 lbs 15 oz just 3 short years ago. He has mixed emotions about the adventure...he loves the toys in the room, but isn't so sure about missing Momma. I did warn his teacher (who taught Kate last year) that Sam in not the chipper, compliant child that his sister is--I have a feeling we'll have more teacher/parent chats this year.

I guess some people are happy to send their kids to school...my sadness comes from looking back on the "baby" years and realizing that chapter is closing. I recognize that there are more wonderful adventures ahead, but I loved that chapter of life.

There's more freedom now (no real diaper bag), the kids are mobile and they love to do new things...but it makes me wonder what is next. So, I'll be spending some time thinking about that...praying...reflecting...

in between...we'll go to gymnastics, Chinese classes, local running events, school, Wednesday kids' church, field trips, and tune up the snowblower...

Taking a Deep Breath...

I rarely comment on politics on my blog. But, after watching this, I am left with no options.

President Obama makes a good point when speaking about preventative treatment and early intervention in the treatment of diabetes. Diabetes is a growing problem in the U.S. and we have not begun to feel the long term effects of this disease. The President notes that primary medical doctors get little reimbursement for early treatment of the disease. While it is true that there is minimal payment for patient education, the President also needs to flesh this out a bit, or maybe he needs to deepen his own knowledge base before speaking.

It's important to note that people diagnosed with diabetes mellitus type 2 have typically had the disease for years. People can be insulin resistant or have elevated blood glucose levels for 6-10 years before the diagnosis is made. Why is this important? Because organ systems are being affected prior to diagnosis. Therefore, you can educate all you want, but the disease is already in process and there still ultimately may be end stage organ damage requiring surgical intervention.

Second, patient education involves the medical provider, the patient and one more elusive, but integral element: compliance. As a health care provider I have learned that you can teach, coach, encourage, chide, and provide information, but you can not force compliance. The patient has to want to make the lifestyle changes necessary to intervene in this disease. Yes, Mr. Obama, they have to CHOOSE to exercise, change their diet, give up fast food, check their blood glucose levels and show up for their next doctor's appointment. These things happen at an individual level with a personal choice. I would propose a close look at the current compliance levels of patients WITH insurance who have the diabetes. I would suggest that they are lower than we would all like to believe and somehow we all appear to have BMI's that are going higher. It is not likely this would change with a government system.

Third, primary care doctors are not the only health care providers that do diabetes education. There are on-line resources, nutritionists, books, certified diabetes educators, nurses, nurse practitioners, seminars, support groups and, dare I say, even the evil drug companies have excellent resources. Imagine what we could learn on our own with little direction.

Finally, I must comment on the suggestion that surgeons can amputate the foot and make $30,000-$50,000. That information is dead wrong and it infuriates me. No surgeon makes that amount of money on an amputation. While it does cost to do an amputation, the surgeon simply is not making that sum and to insinuate he or she is is a misrepresentation and manipulative. Surgical costs include the doctor, operating room set up, operating room instruments, nursing staff, the anesthesiologist, medications, sutures, dressings, and operating room overhead. Those costs do add up, but they do not translate to a $35,000 check to Dr. Hacksaw. If fact, the global surgical fee includes a 90 day period where the patient is seen in clinical follow up with no additional charges for the appointments.

I have seen the ravages of diabetes, I have seen legs amputated and put on the back table in the OR. I have seen compliant patients and I have seen patients who are so apathetic to their disease that its shocking. I have seen hospital bills, I have worked with a surgeon for years. President Obama, come spend a week with me, hold the retractor, mop up the blood, chat with me over a mocha and please speak with a little more knowledge than you displayed in this meeting.

nature center

we went to the nature center yesterday...

kate had a great time...please note pink binoculars in her hand.

she had so much fun that she kissed sam...

sam wondered what he had done to deserve this...

play date treat

Kate has a friend (Little Princess) who has a mom that is very clever. She made this treat for Little Princess and Kate for their last play date. I thought it was such a cute idea that we made them today.

Kate ate 12 of them.

She is a mousevore.

My Monkey--Part 4

she's now officially signed up for gymnastics...

phew