Scott Benner 4/16/23 Scott Benner 4/16/23

#889 Type 2 Diabetes Pro Tip: Movement

A series for people with pre and Type 2 diabetes.

You can always listen to the Juicebox Podcast here but the cool kids use: Apple Podcasts/iOS - Spotify - Amazon Music - Google Play/Android - iHeart Radio - Radio Public, Amazon Alexa or wherever they get audio.

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DISCLAIMER: This text is the output of AI based transcribing from an audio recording. Although the transcription is largely accurate, in some cases it is incomplete or inaccurate due to inaudible passages or transcription errors and should not be treated as an authoritative record. Nothing that you read here constitutes advice medical or otherwise. Always consult with a healthcare professional before making changes to a healthcare plan.

00:00:21 Importance of exercise for diabetes.
00:09:52 Start exercising gradually and safely.
00:11:36 Walking is beneficial for health.
00:21:59 Exercise regularly for better health.
00:22:32 Regular exercise benefits diabetes management.
00:32:30 Stay active and find enjoyable exercise.
00:34:57 Exercise for increased heart rate.
00:40:43 Involving others boosts exercise motivation.
00:45:50 Take time to enjoy life.

Scott Benner 0:00
Hello friends, and welcome to episode 889 of the Juicebox Podcast.

On today's episode Jenny and I will be adding to the Type Two diabetes Pro Tip series. And we'll be speaking today about getting moving. There are easy ways to get yourself going again, Jenny and I are going to talk about just a few of them and why they are so important. While you're listening today. Please remember that nothing you hear on the Juicebox Podcast should be considered advice, medical or otherwise, always consult a physician before making any changes to your health care plan. And I have a couple things here for you just for Juicebox Podcast listeners if you want to try ag one that green drink from athletic greens, I actually drink it every day you can and if you use my link athletic greens.com forward slash juice box you will get a free year supply of vitamin D and five free travel packs with your first order. Now if you're looking for joggers, sweatshirts, sheets, towels, pajamas, that kind of stuff, you can go to cozy earth.com And when you use the offer code juice box at checkout, you will save 35% off your entire order cosy earth.com Use juice box at checkout

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Jennifer Smith, CDE 5:08
I was gonna say before, with your use of the word go v. And as we've like, texted about some things to, you have taken it to a degree to the route that really should be, along with anything that's supposed to impact health and weight and all that, like, you're not just sitting back eating a bag of Doritos expecting that this is going to be the magic trick, right? You know, you're really, you're conscious, you're being more aware than maybe you were before you're making sure that you're eating, you're not not eating because this med can take away appetite or reduce or increase satiety, right. Yeah. So you're I was just going to, I meant to say that that's a good thing that you're doing well, good lifestyle.

Scott Benner 5:56
I appreciate that. Actually, I started recording right before you said that, and I'm gonna keep talking. And I might, I might keep this in. I took my own advice. That's basically what I did was I looked at myself, and I thought, what would I tell other people to do? I'm going to do that. And, and that's, that's what I've done. So I, and the medication, like the specter of the medication, when the doctor gives it to you, it kind of helps you because they're like, Look, if you eat the wrong things, you could end up with, like, some horrible nausea and like, I don't want that. So, you know, but then the doctor is like, but in this first injection, if we go over, you probably won't experience that. I'm like, Well, I'm gonna start eating that way. Now. Just to get myself ready. Like because I don't, I don't want to be in a panic situation where I'm like, I don't know, tossing candies back. And this medication gets ramped up, and I'm like, oh, plus, plus, if there was any value to just wait, I wanted the weight loss value. Yes. And so the one thing I can for sure, say is that I don't, there's no hunger on this at all. Like, the first four days, I was getting hunger in my head. Like I was getting woozy,

Jennifer Smith, CDE 7:06
right, like shouldn't I should be eating something but your stomach wasn't telling it to you. It was more your brain recognizing that your body was giving you some signals of lack of enough intake. But you really weren't, like physically hung. That's not the right way to say it. It's not like you've got this signal from a rumbling belly,

Scott Benner 7:27
let's say Oh, my God. No, it's bizarre, because the only way I knew I was the only way I knew I was hungry is that I was like, am I gonna like, like, pass out? Like, why am I weak and dizzy? Like, do you know what I mean? Like, Oh, I haven't eaten anything. Oh, goodness. And so for the first couple days, I just put timers on my phone. And I was like, eat here. Eat here. Yes, because I didn't know what else to do. I'm back. I have a better flow now. And after I've been on it for a few days, I I am, I have a little bit of it's not hunger the way you would think of it. But it's not like a mask like hypnosis. Like it was the first time when when it first I don't know what's going to happen when I ramp up to a new dosage. But for now, I took my own advice I'm eating carefully cleaner. When I'm, if I have a sweet tooth, I go to fruit. Yeah, you know, like little stuff like that. I'm eating a lot of like chicken and turkey and like some lean beef and stuff. So

Jennifer Smith, CDE 8:31
I'm very proud of you. That's super awesome. Honestly. I think I mean, that's right or wrong long with like, lifestyle things, right? I mean, lifestyle, including while a medication might help lifestyle in many health conditions, is a piece that needs to be included. If the med is really going to help you the way it's supposed to,

Scott Benner 8:53
also wasn't going to waste the opportunity. Like I just thought like, it's not going to happen. What am I going to go back to a doctor six months ago, I'm really ready this time, you know, so I'm just like, I'm gonna go for it here. And, you know, and actually making the series if I'm being honest, has helped me too. Because, you know, telling people, this is how you can help yourself. It would be pretty hypocritical if I didn't do the same thing. Yes, yeah, I will say for the recording that I have eaten like this in the past and not experienced weight loss like this. So um, this stuff's gotta be doing something, I am gonna go I'm gonna get up a hill, a monster to spit on me. That's what I'm gonna do. Listening, you don't get that you gotta go back and listen to the episode before this. But today, today, we're going to talk about something that I think a lot of people need help with. And I'm going to be a great person to talk to you with about it because I easily could be asking these questions. So cool. How do I start to exercise when I'm not a person who's exercised because I don't want to get hurt. And I don't want to I don't want to like break down right away. I think that's got to be the biggest goal, right? The focus in the beginning?

Jennifer Smith, CDE 10:06
I do. And if you I think the majority of people that are listening are also listening because they're ready for a change. And I think that's a step two, any lifestyle change inclusive of adding activity is you have to have this, this motivation of something needs to give here, right? I've got to put some some in some effort in. Does that mean? Oh, gosh, I want to start exercising, so I'm going to buy the new shoes, I'm gonna head out the door, and I'm gonna go run 20 miles, because that's clearly what I have to start to do. That's, you're gonna come back and not want to do anything anymore.

Scott Benner 10:47
Yeah, right. You don't want to beat like you want to. I always say to people around me when they're starting up. Like, don't just go like that, like, let your hair on fire and run forward, because you'll burn out too quickly, and you'll get sore, and you'll skip and then you'll go right back into old things. Listen, this is old timey thinking. But I remember being 1011 years old, and my aunt and my cousin saying that they wanted to lose weight. And they just started walking after dinner. Yeah, it was literally all they did. It was one summer they started walking after dinner. I was stunned even as a child at how much weight they lost doing that.

Jennifer Smith, CDE 11:26
Yes. There are some some really good studies that have been done over a number of years for people, elderly people now who are in there, like, like 90 year old people who have had longevity, obviously, and health during that long life. And what are some of the biggest takeaways? These are people who they may not have done marathon runners, or crazy swimmers or they played tennis like a fiend every week. These were people that walked Yeah, walking was the most common thing for these people who were interviewed to have included long term. And if you're going to start with any kind of even the word exercise, I think, to some people is a turn off. If you think about it by of just increasing movement in your day, right? You might, I mean, most people have heard parked the car farther away. That's something you can do. And if the three trips to whatever store grocer that you're going to a week means that you're parking way in the back of the lot, and you're walking farther in, and you're not having somebody help you all the way out and cart, your groceries, you are increasing your movement. It may not sound like exercise, but you're changing and you're creating a new habit to include more steps than you were likely getting. Right. Yes,

Scott Benner 13:00
I laughed to myself because I do that because I don't trust people near my car.

Unknown Speaker 13:07
But sounds like my husband.

Scott Benner 13:09
I'm like these sons of bitches. And it's windy, they're not paying attention. Don't park

Jennifer Smith, CDE 13:16
next to the car that has car seats. Don't right,

Scott Benner 13:19
Jenny, I will only park if one side is on a curb. If there's a hill, I'll only park on the top side of it. I have a lot of rules about not I can't. If I see a little ding in my car. It ruins it for me. Anyway. So I do that. And I also take my cart back to Yes, like just until you get a little extra and it is it is helpful. I mean, it's safe, more walking than I get otherwise when I'm down marking.

Jennifer Smith, CDE 13:45
And if you're you know, if you're somebody who lives in one of the like, let's say a bigger city that might have some more public transport, whether it's a subway, a metro, a bus or whatnot. Let's say you take your car and you park in a lot and you get on a bus, park your car way to the back and walk farther in to where you get on. If you're standing and waiting for your subway, you could be marching in place. I guarantee you nobody's gonna care. Honestly, if you live someplace that there's a subway that most people take for public transportation. I promise nobody's going to look at you sideways. If you're walking in place, or walk up and down. Don't just stand there looking at your phone. Sorry, calling out people, right? It's the thing that people do, but you could be getting in more steps by just walking back and forth waiting, right? Going up and down on an escalator instead of standing. Walk on the left stand on the right. Be the Walker on the left.

Scott Benner 14:45
I will have an episode coming out a few weeks after this one goes up and it's with this person. We were just talking through ways that people can like lower their glucose values not and it wasn't about people with that. Diabetes, this person who comes on as a guest, she's talking about just everyday average people. And I thought, Oh, I'll have her on and see how what she's talking about might relate back to people with diabetes. And she was talking about calf raises, and how working your calves like just sitting in your seat, like lifting your heels and bending. And she's like that could actually lower your blood glucose. And I was like, oh, Jen, I forget her all explanation off the find it. Yeah. But yeah,

Jennifer Smith, CDE 15:29
there are whole bunches of things like that, even if you have a desk, get and you have the opportunity within wherever you work, get a standing desk, one that you can raise up and down, stand part of your day versus sitting, you actually burn more calories standing than you do sitting all day long. Even if you're just standing in one position. If you have, you know, an underneath of a desk that allows enough space for one of those, it's, it's like a tiny, little pedaling. Like I can't remember what they're called, right. But you could be getting in some movement by doing that, and you're building it into your day where you're already continuing to do then what you need to do. But you're adding it in, which is extra. You know, if you got kids go walk to the bus stop and go and pick them up there in back. These are just, it's not what we would call exercise session, like 30 minutes at the gym with the trainer, right? Yeah. But this may be adding more than what you were doing. And it could start to add up,

Scott Benner 16:38
you know, a pet a desk pedal is what I guess they call it a portable under desk, or you know, you can get them for as low as like $35. Yes. So you all have Amazon, it can be at your house tomorrow, and you don't and you don't need the one that's like 200 bucks. So they that's a great, I mean, that's just that's what we're that's what I'm talking about here, because getting started has got to be the most difficult part. Yeah, I mean, just honestly, with this whole series, I keep thinking that, you know, whether it's going to the doctor, asking speaking up getting a blood test, like the Getting Started part is, is just always kind of the biggest leap. And that's why I'm excited to talk about it.

Jennifer Smith, CDE 17:17
Another one is if you do have some of even news, if you watch the news every single night, or you always sit down to a favorite program that you've recorded, and now you're going to catch up on it either during the commercial breaks, get up, move around, maybe get some simple five pound hand weights, lift them up and down while you're sitting on the couch or your your your favorite chair, or stand up during the commercials. Again, walk in place, do some squats, squats, kind of like the leg raises are, they're a great way to drop your blood sugar honestly, like crazy. So they can these, they could all be added in again, as examples to your day to day normal stuff that you're trying to get done. Without creating too much change in your, I guess what you're trying to do?

Scott Benner 18:09
Yeah, I also think that it can be scary, like the idea of like, we have to start exercising I imagine people think about, Oh, I gotta get a gym membership. I gotta go to the gym, they're gonna be people that are in better shape than me, I'm gonna be embarrassed. I don't want to do that.

Jennifer Smith, CDE 18:20
I don't know how to write that cost.

Scott Benner 18:22
It's a cost. I don't know how to do the exercises. Like I don't think you have to start with that even just like little tiny five pound dumbbells that you could I'm sure grab anywhere you could probably probably things in your house you could use just to just do some current like easy curls to like help the muscle tone come back and other ways to burn calories. You know? Yeah. It just make yourself stronger overall, like your whole body like it doesn't have to start with you know, military style push ups and

Jennifer Smith, CDE 18:53
not at all. And today in today's world, even something like a gym membership doesn't it's not necessary because we have so many tools that are free. YouTube is full of stuff that you can get started with. So again, as you mentioned, if you're if you are worried about how you might look or that you don't have the right clothes to wear or whatever it might be or that the gym membership is just, it's too pricey. It doesn't fit into your budget. Online. There are a number of they you close the windows in your house. Nobody has to see you. You could do it at two o'clock in the morning if that's what your schedule, you know, permits. There's a there's a wonderful it's it's walked down your blood sugar, it's by Lesley sandstone. She does she's fantastic. All of the people actually, in her online videos have diabetes, most of them with type two diabetes, and she has anywhere from 15 minute walks all the way to 45 minute walks going a mile all the way up to three miles And she's she's funny and she's fun to listen to. So that's one that I used to recommend a lot, actually, when I was working with the education

Scott Benner 20:11
when we want people to listen to the podcast while they're working, though, no, no, my I mean, my podcast, that's one. I want to I want to say something kind of like, odd that I make your point. I don't know how many people know Joelle and bead. He's a basketball player for the Sixers. And I read an interview with him recently. And they asked like, because he lived in Cameroon, he you don't think he came here until he was 16. He wasn't a like a basketball player. They asked him how he learned to play. And he said on YouTube. He learned to shoot on YouTube. He said, he said, I went to YouTube, I watched a bunch of videos and I went to the gym and practice. So I don't know what isn't on YouTube at this point. Correct. You know, go find something that will help and stretching to Right. Like I wanted to bring this up, like just getting your body stretched out is such a big deal. Yeah. And again, I think you can you can go to YouTube for that as well.

Jennifer Smith, CDE 21:10
Absolutely. There's even some really good flexibility, yoga, there are a number of different people who have really good free programs, some of them are even like 30 day, and you can start them and each day kind of builds on itself. And they're short enough to fit into a schedule that may not permit a lot of time. So yes, there. I don't, I don't think there's anything you can't find on YouTube.

Scott Benner 21:35
And there's no shortage of people on social media who are sharing their journey as well and throwing a camera in front of themselves and saying, Look, this is where I started. And here's how I've been going. Whatever you need for motivation, but the the movement itself. So how much? How much actual movement? Do I want to start with? Is it a certain amount of day? Is it a certain amount of week? How do I count it a

Jennifer Smith, CDE 21:59
certain amount of minutes, about 150 minutes a week is the goal. And that's a little bit more maintenance, right? If you're really looking for your activity increase, or your addition of activity that wasn't there to benefit loss, we're looking at around like 200 plus minutes a week kind of give or take. And the average recommendation is about 30 minutes of exercise a day, right or five days a week. So

Scott Benner 22:32
and should it be spread out? Like I don't want to, like get up one day and try to put two hours in or something like that. Right? Correct.

Jennifer Smith, CDE 22:38
And I think that's an important point to make more talking. Specifically, in the realm of people who have diabetes, the more regular your activity is, especially around medication use, the more likely it is you're going to have a sort of an overlapping effect on a day to day basis. If you get consistent every morning, I get up I take a 20 minute walk Great. That rolls into the next 24 hours and that day rolls into the next day. So we really do want regularity and not just saving it all up and saying Saturday morning that's when I'm gonna get this 150 minutes it

Scott Benner 23:18
well type to see the same benefit that type one see from consistent Okay, not Jenny's

Jennifer Smith, CDE 23:24
Absolutely, yes, I mean muscles, muscles that build and you build muscles by exercise multiple different kinds, right cardio as well as your weight bearing flexibility. those muscle cells are what respond to insulin and allow them the glucose to be shifted into the places that it's supposed to. So exercise is it's like free insulin, essentially, it Prime's, those receptors on your cells to open up. Because when you move your muscles, they need energy. Where's the energy going to come from? It's going to come from the glucose levels in your body, right or some of it. And so then that decreases your blood sugar levels, which is great. Yeah.

Scott Benner 24:08
So I'm going to ask you a question. I might not be right about with a type two. It's not that they're not making insulin, their body's not using it correctly, and doctors are going to call that insulin resistance. Does exercise help with that? Or can exercise help?

Jennifer Smith, CDE 24:23
Yes, absolutely. That's a big reason for adding exercise is decreasing the amount of resistance that's in the picture? Yes.

Scott Benner 24:32
So the exercise works exactly the way it does and type ones and type twos, like exercise helps your insulin be more productive, you'll need I say, yes. My daughter who has type one is at college. And she had she's decided to start driving to class. And I thought, Oh, I wonder if she's gonna need more insulin like that? Because she because she was walking getting on a bus getting off the bus and humping her ass one way and the other and then all of a sudden she wasn't it And then she got and then you know, the the new semester started up. It's a quarter, the new quarter started up. And she got a lot of desk work again. Oh, so this week, she's like, I'm using so much insulin this week. And I was like, yeah, like you're driving to school, and you're sitting at your desk, and still eating that horrible college food. We have one more quarter to go. Arden requested. She used her accommodation. So I know this isn't for type two so much. But she used an accommodation to ask for a dorm room that had a kitchen in it. Because she's like, I have to start cooking for myself. I have to stop eating this food. Good for her. Yeah. So it was really, really kind of cool. But anyway, they gotta move. Do you remember? What was it the Big Blue Test?

Jennifer Smith, CDE 25:46
Remember? Yes, absolutely. That was where during November diabetes Awareness Month, the Big Blue Test was check your blood sugar, get up and move for 15 minutes, right? 10 or 15 minutes, I think it was and then check your blood sugar again. And post it was really the idea of getting people to see that movement, even if you've got only 10 or 15 minutes, really did have a very quick impact on blood sugar.

Scott Benner 26:10
Yeah, I just remember that. That's something that that had to be 15 years ago and the type one community Right? A long time ago. Yes. Yes. I'm gonna say again, I'm all for one of you listening to like, jump on social media and share improvements with your type two diabetes, the way people share improvements with their weight, the way people share improvements with all kinds of other things, exercise improvement, like just show people, Hey, I did this today in my agency, you know, especially if you have a CGM, you'll you'll be able to go into their the clarity app, if you have a Dexcom. And say, Look, my my agency estimated last week was this and this week, it's it looks lower. And, you know, try to be I mean, if you need that to motivate yourself, great. If you think you can help somebody else is terrific as well. Right? Yeah.

Jennifer Smith, CDE 26:58
And, you know, I think the other thing in the realm of adding activity is people stay motivated when they've got somebody else that is working with them to their goal, right? So if you're somebody who says, I've got this 30 minutes after I finish work, and I want to get out and exercise, maybe there's a friend that will walk with you, right? Because now you're also tying in a scheduling, which makes it more it makes it more like an appointment that you've made. Yeah. And you don't want to let your friend down because you've made this appointment. So you guys, you keep your each other sort of on track with this plan of action. And it's kind of nice.

Scott Benner 27:45
It's a great idea. It really, it really is like a gym buddy, but a walking buddy, or

Jennifer Smith, CDE 27:49
Yes, exactly. Right. Or a pickle, buddy. I mean, I don't know how many people have like, we've got a park right across the street with tennis courts. And last summer, they actually because so many people were playing pickle, or pickleball, or whatever it's called, right? They drew the cord for the pickleball lines, right? All on the tennis courts. Because people were playing it anyway. Right. So you know, maybe somebody has said to you, hey, you know, come play pickleball with me or whatever. And add that in. That's a fun form of exercise.

Scott Benner 28:22
Right? I think back to when I was in my early 20s. I was working with this bunch of guys. And they were playing, I forget what they call it. But it was a it was a game you played with a ball, but it was in a racquetball court. And there was a net, some people on either side, and we would get together and do it like once a week. And that was probably the best time of my life as far as being in shape. And I didn't even think of it that way. It was just moving. It's just fun. Yeah, right. And it was fun. And like, it wasn't difficult either. Meaning it was after work. I used to have a terrible job. So I worked very hard all day, like we were beat up at the end of the day. And we still all showed up and did it. You know,

Jennifer Smith, CDE 29:01
and it was probably that type of activity, you bring in a good point, maybe there's an activity that you can get into that is a it's a release of everything that you've put into your day, that's not been the greatest or that has been really difficult to maybe you can find an activity that's just like a, maybe you go in you box, oh, you take a kickboxing like something or

Scott Benner 29:27
I visited my son recently, and he just, you know, in the last year, graduated from college and stopped playing baseball. And he just one day, he said to me, he's like, I can't talk. I'm gonna go play basketball. And I was like, where he goes, I'm going to the park. There's got to be a game there. Right? He's in a city by himself right now. And he's like, I cannot sit still like this, but it's he's got the mind of an athlete. Like, like, I can't just sit here. And so he went to play basketball. And he's like, Oh, I met some guys like Applying now this is terrific. And then he said to me, I might try to find a boxing gym. Even like he's like that looks like good exercise. And it's just interesting the difference between. And I made this point in another episode, and I hope people are tying this all together. We all drag our five, six year olds to some sport, and they're all able to do it. And some kids keep doing it. And they're not all like, don't get me wrong, right? They're not all like pros, but they can get up and they can go and they can do it. And they're, they're healthy and they're moving. And then some people make a decision to stop moving, and some people make a decision to keep moving. There's no reason you can't make a decision to go back to moving like that correct? You know, there's just no reason you can't do that. So

Jennifer Smith, CDE 30:44
and I think the more that you do that, especially if you have children at home, the more that you do that, the more likely it is that you're by show teaching them that, just because mom and dad are adults, and they're doing all these other things. They're still taking care of themselves, right. I mean, my kids see me exercise all the time, especially now that I have actually gotten nice outside, like temperature. And when I take my kids to take one dough Now, there's another mom I've been talking to. And last week, I got to class I dropped my kids off, I was like, you have fun in class, I'm gonna go take a walk. Because of right I just otherwise sit there and watch them and what's the purpose for me, then I could be doing something for myself. So she looks at me. She's like, I didn't touch that. Can I walk with you? It's like, great. Come on. There was

Scott Benner 31:38
a father on Arden softball team, and we'd get to a practice. And the kids would get settled. And he'd put on different shoes and just take off and run. Yeah, and that's it. He did it every time he used the practice as his time to exercise time, exactly home, and I'm not doing other things. I'm not just gonna sit here and stare these kids practice and softball. So I'm gonna go through this now.

Jennifer Smith, CDE 32:04
Right? I mean it unless you have to be an interactive part of your child's participation in a sport or whatnot. Obviously, it's important for them to see you there and paying attention and cheering them on and all of that kind of stuff. But if there are points at which, clearly they don't even care until you pick them up. Go be busy yourself.

Scott Benner 32:28
There's a list here I found that I'm going to run through real quickly just because I can imagine people are like, I don't want to go for a walk. So ride a bike, walk your dog, which I thought we should like, you know, maybe your dogs like the guy never takes me anywhere. Skipping rope. Please don't do that. If you're on a high floor and an apartment building Frisbee. The gym swimming this hokey hosted dance party. If you do that, please let me know. You This is akin to what Jenny was talking about earlier, use the stairs instead of using an elevator, carry out household chores things need to get done anyway. Just even moving around the house and bending over and reaching around the back of the toilet. And like at least you're moving right? Yoga is brought up here. Again, that's something you could do through YouTube. This is a temporary rock climbing. I'm not doing that. Go for a hike, hula hoop. Join a sport. There are some parks have circuits already set up? Yes. Like if you don't know what they do, you can

Jennifer Smith, CDE 33:31
they're typically like called Vita courses. Essentially, they have you walk a little bit and then you do like a pull up. They have you walk a little bit. And you might do a couple sit ups on like a park bench or something like that. But they've got a visual of how to do the exercise, how many reps to maybe do. And then hey, proceed on down the path from here.

Scott Benner 33:49
This one's interesting. If you bowl three games, you'll walk an average of a half a mile. Now, who would know? I'll say one i i used to love like photography. And then that love of photography. I kind of pointed at my children and now I have way too many pictures of my kids. But when you go out to take pictures, you wander around looking for things to take pictures of it's another good way to keep your mind busy. And not tell yourself oh, I'm out here moving around because I gotta get moving and you know, and spin class at the end. But that sounds horrible.

Jennifer Smith, CDE 34:31
I used to love my spin class. I don't belong to a gym anymore. But I I really loved my spin classes. They were a lot of fun.

Scott Benner 34:38
So what are we looking for out of exercise? Like because this I mean, obviously we're not talking about, you know, we're not talking about lifting weights. We're not talking about doing anything really intense. So what's the feedback I'm looking for from my body to tell me this is worthwhile and valuable for me.

Jennifer Smith, CDE 34:57
Right So one big thing as I would recommend And for anybody starting something they haven't been doing is make sure that you are okay to start it right, your doctor visit, make sure everything's fine. As long as that's the case, then out of exercise you're looking for an increase in your heart rate above sitting down. And right. So you mentioned dog walking before. dog walking is fantastic. But if you take your dog for a half mile walk, and every three steps is a sniff and pee and grab and chew on the stick. You're probably getting a little more movement than you might have been sitting at home, but you're really not getting like, like, walk the dog

Scott Benner 35:47
sense of wandering around the kitchen with trees.

Jennifer Smith, CDE 35:50
Yes, exactly. So you're looking at us an increase in your heart rate. You don't have to be out of breath. In fact, some of the most beneficial for weight loss type of movement is honestly being able to carry on an easy conversation, not like we're having now. But you should be a little out of breath, but not terribly out of breath that you can't actually get words out, right. So thus, the reason bring a friend along, you can have a nice conversation about something but Yes, a bit of an increase in heart rate. A warm if you're moving and we're talking about cardiovascular exercise here. You are going to warm up if you're getting enough movement in.

Scott Benner 36:36
I'm going to bring up something from the podcast. Let me see if I can find it. Oh, there was a guy on episode 713. His name's Adam, he had type one diabetes, the episodes called a rage rocking, because I thought that was funny because I thought that was funny not because that's because not because it has a lot to do with anything. But he he lost weight rocking, which is walking with a backpack that's weighted. And apparently, Jennifer apparently this is Inc reasonably popular. So if you're if you're a person who wants to go on a hike, or you know, just go for a walk and add a little more to it, apparently rucking is a terrific way it's worth googling or looking at or listening to Adam story in the episode because his experience was, I remember being pretty like blown away by what he was able to accomplish.

Jennifer Smith, CDE 37:34
I wonder if rucking came? You know rucksack is actually the term for a military attack.

Scott Benner 37:40
Yeah, somebody, somebody, somebody looked at a bunch of guys who were, you know, overseas, they're like, those guys are all in great shape. Yeah,

Jennifer Smith, CDE 37:47
well, and that's I mean, that's essentially what they do is they go out, and they, they hike with a lot of all of their stuff in their backpack, and it's training,

Scott Benner 37:56
they're carrying their life with them, and they have to carry it. And apparently, it's apparently it's an insanely beneficial. So a thing that from his description, and when I remember looking into it is something that does have easy entry for you. Like, it's, you know, you just grab a backpack at home and put 10 pounds in and go for a walk. And then when it gets easy, add more, you know,

Jennifer Smith, CDE 38:20
and what comes up to me as a another good suggestion for a parent who has a child that is of the size that you can put in one of those carrying or the right, carry your child, if you're gonna go out and take a walk, while pushing a stroller is also something to be said of extra. Carrying that child on your person and walking adds more just like this idea of a weighted backpack. Yeah,

Scott Benner 38:48
yeah. You know, it's funny, it just made me think of something. I went to high school with a guy who's like a land management personnel. And he's one of those guys. he's outside all the time. He carries his gear with him. I stop and think about that guy. He's absolutely chiseled. Yeah, he's just he's got little Ripley muscles on top, a little Ripley muscles. He's outside. He's moving. He's carrying things. I don't think he's setting up a gourmet meal that has cheesecake at the end, probably, you know what I mean, outfield so he's living that lifestyle he's getting and I think that really is what we're talking about. Right? Like there's, there's a lifestyle that leads to an end, just like, just like sitting around leads to an end. Moving around, leads to an end. Yes, I did. Really. I loved your idea of like, including someone else too. I mean, going all the way back to my story of when we were kids. It's my aunt grabbed her daughter. And I want to be clear, like I did not grow up in a family full of people like exercising. Right. There were two exercises I saw done in front of me in that time. It was those walks. And my cousin doing something that involved her going I must I must I must increase my and these are the only the only exercises I was ever witnessed. Oh, that's so fine. Second one did not work for her. If you're wondering,

Jennifer Smith, CDE 40:11
no, it won't work, although it's funny that we're both in the same category of having I totally remember that as well. Yeah.

Scott Benner 40:18
There was this thing with a spring, right? It was Yeah. And you were trying to make your I don't want to be in delicate. You're trying to make your boobs bigger. But that's not how that works.

Jennifer Smith, CDE 40:26
That's not how that works.

Scott Benner 40:30
out, you could have just had a little more milk as you were growing up and that might have done it. Yeah.

Jennifer Smith, CDE 40:36
No, but But yeah, definitely in involving someone else in your plan. keeps you motivated. Because again, you may be even checking in with them. Right. And if you wanted to go a little bit deeper, there are there even, you know, some some tracking apps, things like many of the tracking devices, the tracking watches and those kinds of things. They've got motivational things on them that will even tell you, hey, you know, like my watch, it tells me Hey, get up, you've got 250 steps to get in yet this hour, like you've clearly been sitting on your bottom. So get up and move some

Scott Benner 41:14
right say to like, for a lot of you. I mean, you might have a little natural anxiety to begin with pointed at something valuable. You know, like, if that's a great point, if that app is like, look, walk this many steps, or a lot of you whose personalities you're gonna go, Okay, well, I need to do this now. So sometimes just asking it of yourself is going to make it happen, because it's kind of how you're wired. You could be doing that with, with things that are not beneficial in your life and not realizing it. Like, it's interesting how we can turn things into tasks. Yeah, do you know the mean, and some of them are not always good, but they become repetitive and you do them anyway. Right? Okay. Well, I love the way you just said it now, like involve someone else in your plan. And I thought, if you're robbing a bank don't involve any exercising, tell people tell people? That's exactly right. I say that more than two people can't keep a secret. So eventually, someone's gonna snitch. In this situation, that'd be a great thing.

Jennifer Smith, CDE 42:15
That would be a good thing.

Scott Benner 42:15
What are we? Are we not saying anything that we should be here?

Jennifer Smith, CDE 42:19
Oh, I know, I'm trying to think. Well, I think it goes along with involve someone else, if you are the type of person who really needs some direction. And if you have the means, it may not be a bad idea, with motivation in the picture to just call a gym and see what it would be like to get a month's worth of a trainer. Right? Somebody who can give you a starting place where you are, and give you an idea of how to progress out of that. Even if you're not going to stick with them longer than a month, you've got an idea. Now you've got a base to continue to build on. And it may very well be money well spent.

Scott Benner 43:04
Yeah. Also, if you're looking for another reason to do that, it's a great place to meet people too. It is, you know, in a world where it's hard to meet other people, we were talking about this somewhere the other day. It's hard to date. It's hard to like it's hard to even, it's hard to meet people you're working. You know, some of us are working in our homes. There are days I just go out to go out, because I'm like, I gotta leave here. Now, you know, middle of the day yesterday, my mom was asking for something. I was like, I'll go to the store and see and my brother's like you don't live here. I'm like, I'll mail it to her. I just gotta get out of the house.

Jennifer Smith, CDE 43:39
So you need to see other people in real person

Scott Benner 43:43
fresh air. I got my car I drove I walked around a little bit. I was like, Thank You know, I needed to get away and you don't, it just becomes I don't know, like, the whole COVID locked down. It really shone a light on that for me that if I'm not careful. I could do this forever and ever and ever and ever and ever again and never break this cycle whatsoever. It's you know, it's there's always work to do. There's always something to do around the house like I could, you know, can easily become a shut in no problem. Right, you know, don't be a hermit. Yeah, Herman's Hermits, it's okay, but not like a regular hermit.

Jennifer Smith, CDE 44:21
Find your dog and you've got a dog. Yeah, find your dog. Take the dog to the dog park. You will see people there.

Scott Benner 44:27
I got a great walk the other day because my dog just wandered away. I'm trying to talk to my wife at the back door and we're having this conversation about something and I turned around I was like, where Where's where's the dog? So now I'm like, Oh, I know which way he likes to go and walk in that direction. Also, I stopped to get a sweatshirt because I'm delicate and it was chilly. So

Jennifer Smith, CDE 44:50
you can see your delicate Scott. You're not delicate. Got a

Scott Benner 44:54
little distance on me because I was like, I'm not going out with that sweatshirt. And then he's just five doors down standing in someone's backyard. And he's like, He's so old. And I was like, Andy, what are you doing buddy? And he looked up, he goes, Oh, hey, he looked at me like, I'm lost.

Jennifer Smith, CDE 45:11
I don't smell right anymore. So I don't know exactly which way to sniff back to where I'm really supposed to be. He looked

Scott Benner 45:17
at me like I was standing here waiting for you to come find me. And he's looked at me. He's like, and then he starts like, he forgets he's old. He starts to run. And then he's like, Oh, can we walk? And he looks at me like, let's let's not go too fast. I'm like,

Jennifer Smith, CDE 45:30
Can you pick me up? In fact,

Scott Benner 45:31
he's too big for that. But I hope that doesn't come to that. Oh, gosh. Anyway, Jennifer, I really appreciate you doing this very much course. Yes, thank you. I'll talk to you soon. Hi.

If you're enjoying the type two Pro Tip series, please share it with someone else who you think might also enjoy it. Let me thank better help for sponsoring this episode of the podcast and remind you that if you go to better help.com forward slash juice box you will save 10% off your first month of therapy. And don't forget that full line of contour meters at contour next.com forward slash juice box they are really accurate and very worth checking out. Contour next one.com forward slash juice box. Hey guys, if you're looking for community around your diabetes, check out the private Facebook group for the Juicebox Podcast. There's links in the show notes of your audio player. And if you'd like to hire Jenny, she works at integrated diabetes.com. Just head over there and ask for Jenny

#888 Iron Deficiency Anemia with Dr. Pelcovits

Ari R. Pelcovits, MD has type 1 diabetes and is on the show to talk about iron deficiency and ferritin.

+ Click for EPISODE TRANSCRIPT

Scott Benner 0:00
Hello friends. Welcome back to the Juicebox Podcast. Today, we're going to be listening to Episode 888.

I was so excited to make this episode. I've got a doctor on, he's got type one diabetes, that's how I found him. But that's not why he's here. Today we're gonna be talking about anemia, and low ferritin. Now before you say, Oh, I don't have anemia, I don't have to listen, please trust me, just check this episode out. Anemia low ferritin. And its impacts are very, very, very much under diagnosed. While you're listening today, please remember that nothing you hear on the Juicebox Podcast should be considered advice, medical or otherwise, always consult a physician before making any changes to your health care plan. We're becoming bold with insulin. Couple quick things. If you have type one diabetes, and you're a US resident, or you're the caregiver of someone with type one, please complete the survey AT T one D exchange.org. Forward slash juice box. It will help diabetes research to help you and it'll help me t one D exchange.org. Forward slash juice box. If you'd like to get 35% off your entire order at cozy earth.com. Just use the offer code juice box at checkout. And to save 10% On your first month of therapy. Go to betterhelp.com forward slash juicebox. This episode of The Juicebox Podcast is sponsored by touched by type one touched by type one wants to elevate awareness of type one diabetes by raising funds to find a cure and inspire those with diabetes to thrive, touched by type one.org. And I'm going to take this opportunity to talk about the podcast just for a second before we start. So sort of an ad for the podcast. A lot of the management stuff is broken up into series defining diabetes defining thyroid, the diabetes Pro Tip series, the bold beginning series, there's an entire collection of algorithm pumping episodes, ask Scott and Jenny, just episode upon episode of listener questions answered by myself and Jenny Smith. There's the diabetes variable series, the mental wellness collection, how we eat, and very new to the podcast, a type two series for people who are struggling to understand what their Type Two diabetes means or how they can get started with helping themselves. And of course, the after dark series, which has a long list of interviews with people living with diabetes, and their stories that let's just say don't usually see the light of day, you can search for the series within your podcast app, like you could say defining diabetes juice box and it would come right up. Or you can go to juicebox podcast.com. And there's links at the top of the page in the menu section that will allow you to see every episode that's in every series and collection and then you can just go to that episode as you please. And if you're in the private Facebook group, and please I hope you are in the featured tab. There's a tab at the top that's called featured. There's lists of all of these series and collections there for you as well.

Ari R. Pelcovits, MD 3:29
I'm already Palca that recently diagnosed type one diabetic and also a Hematologist Oncologist in Rhode Island. And happy to be here today.

Scott Benner 3:40
Good morning. How are you? I'm doing well. This is one of these odd situations. You ever hear somebody say I have x disorder and I can't wait for someone famous to get it so that they pay attention.

Ari R. Pelcovits, MD 3:54
Yeah, no. Yes. Yes. That is sometimes the best thing that can happen to any disease and someone famous getting that.

Scott Benner 3:59
So for my situation and what I'm trying to accomplish a hematologist getting type one is perfect. Sorry for your trouble, but I'm looking forward to picking your Yeah. Well tell me first How old were you when you were diagnosed?

Ari R. Pelcovits, MD 4:16
So I just got diagnosed about five months ago, and I'm 36 now so I was 35. Okay,

Scott Benner 4:22
is there a history of autoimmune in your family?

Ari R. Pelcovits, MD 4:24
You know, really little, my mom has Hashimotos which I feel like, you know, a lot of people too, but outside of that, I was sure I was gonna get cancer. I mean, that's kind of why I wanted to be in hematology oncology. And so it was it was a nice surprise. When I got this diagnosis.

Scott Benner 4:39
We wait You thought you're gonna get cancer. So you became a hematologist? Tell me about that. Exactly.

Ari R. Pelcovits, MD 4:43
Yeah. Well, you know, my mom have had breast cancer, which he's doing great from, and my brother when I was a kid had lymphoma, also, he's doing great. So just a lot of life experiences that I think led me down the path towards oncology, and then always in the back. I mean, I don't know if it's true every doctor but I think a lot of doctors are hypochondriacs and assume they're gonna get almost every disease, but most likely also assume the ones they treat they're gonna get because they see it all the time.

Scott Benner 5:13
Well, I can tell you this, that a lot of people who need therapy become therapists. I don't know why that

Ari R. Pelcovits, MD 5:20
Exactly, exactly. Yeah. Although my endocrinologist told me other day that maybe I should take my endocrinology boards now just for fun.

Scott Benner 5:28
Well, you're a, you're a well educated man, you certainly went to a good medical school and tell people where you went and what you're doing now.

Ari R. Pelcovits, MD 5:36
I went to medical school at the University of Maryland where I grew up. And then I came up to Rhode Island and did my residency and fellowship at Brown University. And now I've stayed on and I treat patients with both cancerous and non cancerous blood conditions.

Scott Benner 5:51
And that explains why your internet stinks. Okay.

Ari R. Pelcovits, MD 5:55
That's exactly.

Scott Benner 5:57
Alright, well, I will not go down the rabbit hole of Rhode Island. I'll skip right over that. That's fine. And, and just say how long you've been practicing?

Ari R. Pelcovits, MD 6:07
Well, so actually, I'm just out of out of training. So you know, medical training, just to be fun takes forever. So my training was seven years, and now I'm about six months or no longer nine months out of training. So I'm almost finishing my first year in training.

Scott Benner 6:20
Wow, that's insane. Well, I appreciate all the effort you put into it. It's really, really something honestly, may you live long enough to pay off your debt?

Ari R. Pelcovits, MD 6:32
Make it worth it? Yeah. Okay.

Scott Benner 6:33
So tell me a little bit about how you manage your type on. Yeah, so

Ari R. Pelcovits, MD 6:37
I currently am on a pump. I'm on the tandem T slim. And I have Dexcom, which I was able to get pretty quickly, I think, was on MDI just for a couple months after diagnosis, and then got on a pump, maybe about two months ago or so. And it's been pretty awesome with the pump since then.

Scott Benner 6:57
Are you using control? Like you? Yeah. How do you find it?

Ari R. Pelcovits, MD 7:03
You know, I find it overall good. I eat I wouldn't call myself like a low carb person. But I definitely changed my diet since diagnosis and much more of a low carb on the end of the low carb things. So I think, you know, I stay pretty steady from that perspective. And I don't think control IQ has to do a ton of work. It is interesting where I didn't notice, like I think with Lantis you know, I kind of knew what was on board always. And with the control IQ the way it's kind of adjusting things. It can have some impacts where you know, some days I have more insulin on board than others just because for whatever I've been doing, it's decided

Scott Benner 7:40
I needed more. Yeah, you're using Lantis out the box. Yeah,

Ari R. Pelcovits, MD 7:44
I started on Lantus and fast acting with with males.

Scott Benner 7:48
Okay. Hey, are you did you put on a headset with a microphone? I did you just move it a little farther away from now from your popping a little bit? Yeah. Is that better? Yeah, we'll find out. So okay, all right. Well, I don't want to skip over your diabetes, but I have a lot to ask you. So yeah, that's fine. We can come back to my diabetes. Okay. Where does this begin? Where does my obsession with understanding people's iron and ferritin levels begin? I guess, if I look back over my life, I was a person who was tired all the time. I didn't know it. If I came to your house to watch a movie, you know, back when people rented videotape, so if you remember that. Yeah. I would be asleep halfway through the film. It was a joke. We go to a theater. Scott be asleep. Come to the house. Scott's gonna fall asleep. I have fallen asleep. Driving a car. Oh, gosh. Okay. I mean, in in moments when you probably shouldn't just, it just became a thing. Sort of just like, and it was always put on me. By the way, there it was. It always was. I was always treated sort of like, oh, like he can't even stay awake. Like it was nobody ever thought anything medical. They were just, you know, anyway, 80s 90s. I don't know if people realize how much more the world's come along because of the internet and things like that. But back then somebody made a snap decision about you. And that was it for the rest of your life. Right? You were sleepy. So I'd go through bouts of it where it was terrible. And then it would get a little better go back. I'd get used to it. I was good at pushing through it. I guess one day, I just said to my wife. I feel like I'm going to die. And I didn't know another way to put it. I was like, I'm like if if this isn't what dying feels like then you know, I don't know. So I went to a battery of different doctors. And my ferritin level comes back very low. I think like 13 Maybe. And, of course, like I didn't realize it at the time, but everybody in the room looked at me like oh poor guys got cancer. like that, that's now I look back. I know that was the look I was. Yeah. And how old were you then? Oh God in my 40s, my mid 40s Okay, you know, and then the battery of tests, we're gonna put it through, we're gonna put a camera up your ass, we're gonna put a camera down your throat here swallow this giant pill, it's got a camera in it, like, like, all that stuff. Come back. And the answer is, huh, there's nothing wrong. I was like, okay, so any reason you can think that you would have blood loss? And I said, I've had one pesky hemorrhoid my whole life, but I don't know that it's bleeding that much. You know, like, meanwhile? I don't know. Like already. I don't know. Like how much blood loss is blood loss? Right? You know? No, yeah,

Ari R. Pelcovits, MD 10:49
you what looks what looks terrifying to you sometimes in a toilet bowl is actually kind of mild compared to what will really drive your numbers down.

Scott Benner 10:56
What a nice thing to say. And it's so anyway, then some tests come back. I have something called Berets. Okay, and maybe you're not absorbing iron correctly, Scott. You know, I don't have celiac. I don't have like, you know, like that. All that. So I'm like, Okay, so what's this Berets? And then you might be able to explain it better than it was explained to me. But it's been. I kind of assume it's like a precursor to a can a soft to cancer. But

Ari R. Pelcovits, MD 11:28
yeah, doesn't necessarily have a GL was the word I think you were holding back on.

Scott Benner 11:32
Thank you. Because I wasn't certain. So cursor, esophageal cancer, but doesn't have to be that and, and take this thing and keep, you know, keep your stomach acid down? Well, at that moment, I was like, Well, I'm just going to change the way I eat. If, if that's it, because I didn't, I did have heartburn, like throughout, maybe not throughout my life, but it was getting worse. So I cut out like oils. It's a strange thing. But I cut all oils out. I stopped eating later at night, like little things like that. And I was actually able to deal with it on my own.

Ari R. Pelcovits, MD 12:06
Without any sort of medicine for the heartburn. Yeah, I

Scott Benner 12:08
used the medication in the beginning, but then I got away from it. And I still keep like a, I don't know, like an acid like a chewable by my bed in case something happens, because I've learned not to ignore it. But I mean, I might be used those. I don't know, once every six weeks, something like that. So and that's and

Ari R. Pelcovits, MD 12:27
you're still getting iron infusions now or you sort of got it and you're done. Oh, no,

Scott Benner 12:31
I get the iron infusion. I feel like a million bucks. Six, eight months later, I start tailing off again. And then I gotta get him again. Yeah, I've had iron infusions. I've lost track. Now. Honestly, over the last couple of years, I've probably had 10 of them. And I, you know, I take my biggest my biggest leap was that the doctor kept saying, Well, maybe it'll hold on. And then one time after an infusion, he retested my iron in my heart and was so high that he was like, Oh, good, you don't need to take a supplement anymore. And then I was like, Oh, I'm good. And then I didn't take the supplement. And then of course, eventually, it dropped back. Right?

Ari R. Pelcovits, MD 13:12
I mean, your story that your story is so classic for the type of patient I see with iron deficiency. It just the number of people I see who go down that same path of, you know, where's the blood going? Where's the iron going? We can't find it. But clearly, something's going on here. And they need iron to feel better. Yeah, I'd be happy to kind of run through, you know, why we think that process and you know, what are sort of when someone comes in with low iron, what we're thinking about and why they thought you had cancer? If that would be helpful, please do. Yeah. Yeah. So you know, well, the main thing is that we need iron to make make our blood and that's why we care about it. And so oftentimes, if you don't have enough iron, you also then won't be able to make make enough red blood cells. And that's when we use the word anemia, so become anemic. And I think for a long time, people thought that it was only if you became anemic, that you would start feeling crummy. But clearly, there's tons of people like yourself who just having low iron makes them feel awful, tired fatigue, no energy. And the way we can sort of not have enough iron in our bodies is usually one of two mechanisms, which is either we're losing it in the blood, because the iron that's in our body is mostly in blood. So whenever we bleed the iron in there, it gets lost. And then our body uses up whatever sort of iron stores we have. Or we're not absorbing enough iron. And so and someone who's over the age of you know, we used to say 50. But now with this happening younger, probably even over the age of 40. If you come in and especially if you're a man and don't have any other reason to be losing blood, we certainly worry could this be a cancer in the GI tract or colon cancer, cancer higher up that's causing you to lose blood and that's why you have low iron

Scott Benner 15:00
Oh, to say that I don't feel well. By the time I was able to tuck a hematologist into giving me an infusion. And it was really like I had to bang on people's heads, because the last thing they made me do was eat. Even though I didn't have any signs from testing of celiac, they made me eat a gluten free diet for a month. Oh, interesting. And so I'm eating a gluten free diet. And one day, I'm in my kitchen, and I just bend over to pick something off the floor. And I almost went headfirst into the floor. Like I was diving into the floor on purpose. I just couldn't hold myself up anymore. I was at the point that no matter how long I slept, and when I got up by 1pm, I couldn't function anymore. And I took myself to the emergency room.

Ari R. Pelcovits, MD 15:53
And were you were you? Did they make you go on iron pills first?

Scott Benner 15:56
Oh, I had to do everything. Everything that everyone knew wasn't going to work I had to

Ari R. Pelcovits, MD 16:01
write did you get the bad constipation from the iron pills? No, because

Scott Benner 16:04
I used a really good formulation to do it. I used I use the thorn labs iron I mixed it with a their vitamin C brand and I didn't have any trouble with that. I've also learned by trial and see works really well. Okay, but point being I wasn't just didn't feel well, like I was shutting off. And, and so I went to I went to the emergency room. I because the doctor still wouldn't give it to me I hadn't completed all the things I had to do. I told my wife, I'm like, I'm not gonna make it to the end of what he needs to do. And I explained everything to the ER and some lovely doctor in the ER gave me a small iron infusion not nearly enough, right? And it was that enough to like, Let me hold on until until the doctor was fine. Then they put in that first infusion waited a week gave me a second one. And I'm gonna say that in a month, maybe six weeks? i It changed my life, like I was just met. And is that because you have to remake red blood cells with the new iron in your system? Is that right? Yeah. So

Ari R. Pelcovits, MD 17:15
it depends. So if you if you're also anemic, so we sometimes use these words interchangeably, and it can get kind of confusing. And I think especially if people go and donate blood a lot, they'll sort of say things like oh, your your iron is good today when they're actually not testing your iron. So you know, you have your your hemoglobin and your red blood cells. And when those are low, really the word is anemic or anemia. And then you have your iron. And you can have low iron and ferritin is a what we use to measure sort of how much iron you've got kind of stored up in your body that's available for use, if you have or

Scott Benner 17:55
just a quick reminder to go to touched by type one.org. And to find them on Instagram and Facebook. At touched by type one.org You go to programs. And then you can scroll down to see everything that's going on the annual conference, an awareness campaign, a dance program, dancing for diabetes, they have a D box program, a golfing event, and other stuff, videos and pictures what they're doing links to get started. And by the way, that annual conference, let me click on it and see if there's a date listed yet. Because I'm going to be speaking at it. Oh, it still says Stay tuned for 2023 announcement date. What we're getting close. And I think I know the date. So go check it out. It's a great event in Orlando. And by the way to say it's a great event is an understatement. Beautiful facility, wonderful staff, great speakers. And I mean, I'm going to be there so touched by type one. dotwork Hey, if you're feeling overwhelmed, and you'd like to have some talk therapy, you can get 10% off your first month of therapy at better help.com forward slash juicebox just signing up at that link saves you 10% off your first month. Again, you can save 35% off your entire order at cozy earth.com By using the offer code juice box at checkout and athletic greens athletic greens.com forward slash juice box I think you get free. Yeah, vitamin D for a year and five free travel packs with your first order at my link athletic greens.com forward slash juicebox. And don't forget juicebox podcast.com To find the series and the collections. And please subscribe and follow in an audio app like Apple podcasts Spotify or wherever you get your audio I hate to say that

Ari R. Pelcovits, MD 19:54
you disagree. First thing that has to happen is you've got to make my red blood cell sorry

Scott Benner 19:57
I'm sorry you disappeared again but we're on a good day. Yeah, so let's keep going ferritin from there,

Ari R. Pelcovits, MD 20:03
yeah, so ferritin is a measure of how much iron you have left in your body sort of leftover for you to use. And so if you also have anemia, if you don't have enough red blood cells, when you get an iron infusion, your body first sort of takes that iron to make new red blood cells. And so if part of the reason you're feeling so crummy and fatigued is because of the low red blood cells, then it's going to take a little time for those to get made. But then you're also going to need to sort of replenish those iron stores. And sometimes it's just redistribution of what's been put in your body, and everyone's going to be different. And I know I think you're like the ideal patient your response. And you know, when I see people for this reason, I often try to caution them and say, Look, you know, lots of different things can cause people to feel terrible. Clearly, the only thing we found right now that's doing it is low iron. And so I'm gonna give you this IV iron, and my hope is that you have the Scot response. And, you know, four to six weeks from now you feel like a different person. Yeah. It doesn't work that way for everyone. You know, some people will get okay, I feel a little better, but something else is happening. Some people, especially when it's just low iron, and they're not anemic, I give them the iron and they really don't feel any different. But and not not the question, sort of the care you are getting, you know, IV iron is a pretty safe medicine, they probably talk to you about this, the sort of the main side effect we worry about is very few number of people can have an allergic reaction to it. Yeah. Outside of that, you know, cost and things like that you certainly want to think about but I'm pretty liberal and who will at least give it a shot with it too. You know, and if you're someone where I give you the IV iron and you have no response, you know, you don't feel any better. And there's nothing dangerous about your numbers. Well, then sometimes I'll say okay, we'll give it a try. And clearly this is something else.

Scott Benner 21:53
No, for sure. i And to your point about perhaps having a reaction. I think the first two times they gave it to me, they gave me IV Benadryl to and then after you don't have a reaction a couple times, I'm like, I'm gonna say no to the Benadryl.

Ari R. Pelcovits, MD 22:09
Yeah, that was the right thing to do.

Scott Benner 22:12
This is ruining an entire day of my life. And I don't use the Benadryl anymore. As a matter of fact, I go in there, I'll tell you, one of the most difficult things about getting an iron infusion for me, is that I walk into an infusion center, where everyone has cancer. Yes, and I I roll in 20 years younger than them, probably looking like a million bucks. And I'm like, What's up everybody, I'm here for my butt. So I keep it very, I keep my head down, I walk in very solemnly, it seems like a very, it's almost seems like a religious setting. I don't know another way to say it, you know, and, and I walk in, I keep my head down, I get my iron and I keep my mouth shut. And I leave, just try to be respectful to everybody. But the, the response I have is insane. Like, like, it just happened again, where it was four weeks ago. And I said to Kelly, I'm like, Oh my God, my iron slow. And we were getting ready to go on a trip where I was gonna have to drive to, you know, the East Coast, I was going to drive from Jersey to Atlanta. And then in like, and then back again, like 10 days later. And so and so I got went through the whole process, I knew my insurance company was going to say, okay, because you know, we've gone through it before, and I just got on the phone with them, like, I need this before I leave, I grow my iron won't kill me, I'm gonna have a car accident, you know. So I'm like, I have to go on this trip. So they were able to sneak one in before I left. And about three days into my trip, I said to Kelly, I'm like, I'm starting to feel a little better, like, and then it progressively got better. I got back, I took another infusion. Now it's been maybe two weeks since the second infusion. And then so many things like little things in my body get better my muscle tone picks up. My GI tract works better. You know, energy all that's right back again, my mental clarity is back. Like there are episodes of this podcast where you guys won't know it. But I'll think around words, like I'll be making the podcast. And I don't know how other people's brains work when they're, I can I can feel what I'm going to say before I'm saying it. And I can look ahead at my sentence and go I can't find that word. And then I'll talk around needing the word. And that happens when my arms lower too.

Ari R. Pelcovits, MD 24:32
So not not to talk too much about diabetes. But what I will say is that since getting diagnosed, I think one of the lessons as a as a doctor I've tried to take from my experience is listening to the patient. And this has been true both from my own experience, but also kind of listening to the podcasts and on the Facebook group. And just, you know we have our textbooks and we have what we're taught. And certainly you don't want to just run away from those and start practice. The same, you know, crazy medicine just for the fun of it. But it's clear that that's not going to capture every patient experience. And the people, you know, and this has been said over and over again. But the the people who are the best experts in any condition are the people who have it. And so kind of what you're describing with this, you know, your response to IV iron is, I mean, could I find every every symptom? You just said in a textbook? No, but but why would I deny what you're?

Scott Benner 25:31
I'm assuming you're just going to come back in a second.

Ari R. Pelcovits, MD 25:33
Iron? And could you give me an iron infusion? Well, I'm not going to go kind of try to do that, because that wouldn't make any sense. But, but listening to people and sort of saying, Look, you're having this experience, I have a medicine that can make you better that I think within the risks and benefits of what's safe and appropriate, and within sort of what we consider appropriate medical practice, you know, listening to the patient is really important.

Scott Benner 25:55
Is it? Or is it that? Is that that low iron can't cause some of the things? Or is it that just historically, and traditionally, you don't attach? Like muscle tone to that as an insult? Yeah, I

Ari R. Pelcovits, MD 26:12
mean, I think it would probably be that, well, here's what I would say, taking a step back, I think the reason anemia, the reason when your red blood cells, your hemoglobin gets a low, you feel tired, kind of makes sense from a scientific perspective. So your red blood cells carry the oxygen all around your body. So when that gets low, you know, on some level, you kind of, you know, make sense that you're probably not delivering enough oxygen to all the tissues, and so you're going to feel tired, weak, etc. The reason that when your iron is low, you also feel that way is not quite as clear. Because you would think that if your red blood cells are high enough, then okay, so you don't have enough iron in your bank. But I'm still getting all the oxygen I need everywhere it needs to go. But again, it's so clear, and this is not controversial, that there are people who have these symptoms when their iron is low, yeah, without anemia.

Scott Benner 27:05
And I'll tell you that I've now met so many people because of the podcast. And that, and I, and I'm thinking too, because all is this? I mean, can you step back and imagine that this isn't crazy that my daughter has type one diabetes, my son has Hashimotos and I have trouble with iron. Is that is that somehow connected? Because why am I meeting so many people who either have type one, or kids have Type One, who are also talking about the same symptoms, and have the same test lab results around their iron in their ferritin?

Ari R. Pelcovits, MD 27:41
Yeah, I mean, I think the main way you would want to tie it all together would be celiac, because that would be the sort of other autoimmune condition that you know, would run in the family and would cause low iron. So outside of celiac or Crohn's disease, ulcerative colitis, these other autoimmune conditions that impact your gut absorption, I can't say there's a clear way I can connect it probably it's more coincidence than just that iron deficiency is really common. But I mean, you know, maybe there's something there that

Scott Benner 28:12
we need to investigate. Why do you think iron deficiency is very common?

Ari R. Pelcovits, MD 28:16
Well, so when, in young women, almost any woman who's having her period will have some amount of iron deficiency. So, you know, you test that anyone, you know, between the ages of, you know, when they have their first period until their last, they're gonna be probably, you know, a good chunk of those people are gonna be iron deficient. And then we have, you know, again, I think it's more that is symptomatic iron deficiency as common as just iron deficiency. So sometimes we end things in medicine, we go looking for them, and we find them. And it's, but does that necessarily mean there's a problem there? And some of that is sort of the test with treatment. So do we give a treatment? And do people feel better? And there's a lot of people who, who aren't like you who like I said, Well, we'll only have a little bit of low iron there, you know, hemoglobin will be normal, and I give them some IV iron, and they really don't feel any better. And so those are the people where I say, Look, we found this by accident on bloodwork, I don't want to sort of give you extra medical bills, extra visits, just to sort of solve a number, if it's not really making you feel any better.

Scott Benner 29:11
Well, I know it makes me feel better. There was a day where I needed an infusion. And they're like, we can't we don't have a chair and I said, I'll drink it. And she said, and she laughed, I said, I'll do it in the parking lot. And she laughed again. I said, if you think it'll help, you can stick it up my ass. Because I need this future. And, and they laughed and found a way and I'll tell you this too, a number of years ago, probably four years ago now. My son had a lot of the symptoms. And he was a college athlete. He was like killing himself, you know, and we got him some blood work in his part and came back very low. And we got him an infusion and it changed things for him but now he just takes a supplement. And it's he seems to be fine

Ari R. Pelcovits, MD 29:59
and they never found because in his case, well, no,

Scott Benner 30:01
but about two years later, he was diagnosed with Hashimotos.

Ari R. Pelcovits, MD 30:05
Okay. Okay, so that definitely could have been playing a role. Yeah. So

Scott Benner 30:08
now he just takes a supplement, you know. And I'm actually I don't know the name of it, but I just started seeing an endocrinologist. So I went into the doctor, I was like, Look, I and I'm telling you this to see if you see a connection to my body is always carried extra weight. I say all the time on here, and anybody who will listen, I am the fattest guy who doesn't eat that you'll ever meet in your life. And so I do not consume food, commiserate to my body. And so I went to this Endo, and I'm like, Alright, look, the kids are gone. Like God bless them. Hopefully, they'll live but it's time for me to try to stay alive. You know what I mean? And battery of tests, and she comes back and says people would kill for your bloodwork. And I was like, I wanted to be happy. And I was like, Alright, great, but no answer there. You know, like, Why does my arm keep falling? So she wants to put me on something a little stronger as far as iron goes than what I'm taking now. And I said, Well, what about the weight? And and to give you some context already, like I stood in front, I've known this woman a long time. She's been on the podcast, actually. And I'm going to bring up something that she told me in a second to see what you think about it. But I so I know her. You know what I mean? Like, we're not we're not friendly. But we know each other very well. I stood up in her office, and I said, How much do you think I weigh? I was like, be honest. Just I mean, you look at people all the time, what do I weigh? And she goes, I think about 175 pounds. And I said, Yeah, I'm 233. I'm like, I'm like, what, like, so that's part of the problem, too, is I carry it well enough. That like, I don't personally look at myself and go, I have to lose weight. Like, do you know what I mean? Like, it's that kind of feeling. So she's like, What do you really? And I was like, yes, she examined me. And she goes, I'm gonna put you on Wigo v. And I said, okay, like, right on. So yesterday was my second injection, I'm still not on a therapeutic level of it yet. I'm taking, I don't know, whatever. This is, like point two, five milligrams, I'm down seven pounds. Wow. And so I got to the point where I'm like, I'm 51. I don't even care why anymore. I just, I don't want to have a heart attack. You know, like, like that. That's that, like, you know, so I'm, I'm getting out of this anyway. I can.

Ari R. Pelcovits, MD 32:32
Yeah. But so. So yeah, so obesity? And weight? Oh, man, you know, you could do and you maybe already have, and I haven't seen it, but you could, you could do, you know, podcast upon podcast about that. And it's certainly not my area of expertise. But, you know, what I would share is sort of a few things. I think, like many things in life, you know, I think there's probably extremes, and then there's the truth somewhere in the middle. So, you know, there clearly is, you know, we call it sort of, you know, an obesity epidemic, or whatever term you want to use it, there has been a rise over the last several decades in, you know, people's weight and obesity. There's also clearly, you know, some link between weight and bad outcomes in healthcare. So, as your weight increases your risk of certain things like heart attacks, and some cancers goes up. But, you know, at what point that happens, exactly. So, you know, at what point do you cross the threshold where, you know, if I weigh this amount, now I'm at risk for a heart attack is is a bit unclear. And, you know, there's probably some amount of being slightly overweight, that's not quite as bad for you, as maybe we've been sort of led to believe in our general culture of thinness. Sure. It doesn't mean that, you know, living a healthy lifestyle isn't important. But I think it's like, how do we focus on the numbers? The other thing is, there's certainly some data about where your weight is as important. So probably carrying your weight in different places in your body can lead to different outcomes. And that's not a choice you can make. That's just the way your body is

Scott Benner 34:05
right. Yeah. And I'm carrying it in the wrong places because it my arms, my legs, my ass, I looked like I weigh 175 pounds. So not great. And, and so, you know, that's but do you see any? Is there any relationship to carrying extra weight and anemia or low iron or low ferritin?

Ari R. Pelcovits, MD 34:27
No, not particularly. I wouldn't think I mean, again, you know, maybe you could, you could sort of try to connect things where, you know, the low ferritin the anemia is making you, you know, more tired and weak and so you're living a less active lifestyle. But again, the sort of science of weight loss and weight gain is, I think, so complex. And, you know, I think what these medicines like what Goby have taught us is, every everything before this where we've tried to get people to lose weight by restricting what they eat and you know, putting them on intensive exercise regimens, never works, and the majority of people can't keep that weight off, or a lot To people doesn't even work. And so there's something about these medicines that are working in an entirely different way. But yeah, I couldn't I couldn't say that just being overweight is going to lead to low iron.

Scott Benner 35:10
No, no, but could low iron lead to weight retention?

Ari R. Pelcovits, MD 35:14
I think the only way I would imagine is sort of through a sort of decreased exercise type of situation where you're just a less, you're being less active because you have less energy. Well, I'm sharing

Scott Benner 35:24
it and bringing it up, because I don't know I just, if it helps somebody just to put, you know, connect some dots for themselves, then that's it. I mean, the amount of people who after I, I talked on the podcast about having my iron below, the amount of people that reached out is stunning. Like, like, really, really stunning. It's almost like thyroid and you know, oh, you're in range. So we won't give you the hormone. But but, you know, once they heard me say, I, you know, we manage Arden's thyroid, to under two, like, that's the goal, like her TSH needs to be under two, that's how we're managing. They're like, Oh, but mine's four, and I have all the symptoms, and my doctor won't blah, blah, blah, and like, that just happens over and over and over again, there's got to be some sort of a metabolic balance to your body. And that if it's too far out of whack, I just, I think things just can't work. And, you know, I have no medical experience, but I can tell you that I have a number of little things wrong with me. And once I, once I put them in a better situation, things improve that there's no connection to I mean, because of Arden's trouble with food, and digestion, probably from type one, I started taking a digestive enzyme with my meals, and it's really improved my life. So what the hell who cares? Why I don't even

Ari R. Pelcovits, MD 36:49
exactly know. I mean, I think that goes back to this sort of what I was saying before about, you know, listening to patients, but also the humility of practicing medicine. So, you know, don't try not to come into, you know, when I meet a new patient, not trying to come in thinking I have this ego that I know more than them, but really listening. And like you said, when you encounter something that's making someone feel better, you know, make sure you don't harm someone, don't tell someone to do something that's going to hurt them. But listen to people and believe them when they're feeling better. And like you said, if we can't explain it, but it's it's overall leading to better outcomes. And sometimes that's what's most important.

Scott Benner 37:22
Yeah. Okay. So Dr. BENITO came on did a long episode about thyroid. And in the middle of it, we talked about iron on ferritin, a little bit. And she said, her patients, a woman of a menstruating age, she thinks of a ferritin of 70, as absolutely minimum. And I wondered what you thought about that?

Ari R. Pelcovits, MD 37:48
You know, that's a little higher than I would, again, well, that means taking a step back again, I think it's what do we mean by by low and not just treating the numbers? So, you know, going back to this concept of iron deficiency and anemia? I think it depends on what's going on, and why the I'm seeing the person. So if someone's been referred to me, because someone checked the ferritin level, and it came back at 25. But this person feels fantastic. They're not anemic, you know, they're running marathons, then I say, just look, just watch it. Right, I don't think there's been any clear evidence that simply pushing that number higher necessarily is going to, you know, make things better for them, right, where simply that same person could walk in with that ferritin. But if they're feeling crummy, then I might say, let's give this a shot and treat it. So I think the number itself, although certainly, you know, there are going to be normal values. It's going to depend a little bit also on how that person is feeling. Yeah.

Scott Benner 38:48
No, I agree. And I don't think she meant, you know, if everything's happy, go lucky. And you're 70 I need to give you more iron. But I but I think she means for people who are, are complaining of these issues, that she still thinks of 70 is as lower. And I mean, I don't know, this woman is an integrative endocrinologist. She's helped my family significantly. She's managed thyroid levels when other people wouldn't have touched them. She's just been like, she's just a little. She's not crunchy. Like, it's all very scientific. But right, but, but she's just seems to be on the bleeding edge of what she's doing. Right. Right. And

Ari R. Pelcovits, MD 39:32
yeah, I mean, again, I think that I would, you probably have to twist my arm a little bit to get me to treat someone just for Farrington. You know, if you came in and you were labs look pristine otherwise, and you're feeling crummy, but your ferritin was 60. I don't think I would be rushed into to give that person you know, IV iron.

Scott Benner 39:50
So when you give it to them orally, though, is there really a chance of it helping? And do you think this is going to be a two prong question? Like, is, is the state of our food? The reason for this? Like, are we just not eating iron rich foods?

Ari R. Pelcovits, MD 40:09
That's a good question. You know, I don't, the what we can absorb through food is somewhat limited. So if you get into an iron deficient state, so if you have some sort of bleeding event, right, let's say you've never had iron deficiency before, but you get an ulcer in your stomach and it gushes out blood, it's hard to get your numbers back to normal without some amount of supplementation through pills, or IV, you know, just eating a lot of steak isn't going to always do it. So but on the other side, it's a little not impossible, it's hard to become iron deficient, just by you know, being a vegetarian. Again, oftentimes, when I see people probably like yourself, where we can't find the exact reason, it's probably a combination of things. So it's, you know, they've not been eating a lot of iron rich foods, maybe they've got a little bit of bleeding, we can't find, or I have more that's been bothering them for 30 years, they might be on a medication that's blocking some amount of iron absorption. So it's maybe not one thing alone. But all of these things added together. To be honest, we probably eat too much red meat as a society. So I can't say that we're not eating quite enough iron, although, you know, we have iron and a lot of other foods as well.

Scott Benner 41:20
I do my part on red meat and helped me at all. And so is it. Does it make sense to you that about every eight months I, I just deplete?

Ari R. Pelcovits, MD 41:31
Yeah, so you're probably having my guests if you know, is you're probably having some amount of small amount of bleeding. That's ongoing. And so it's, it's slow, and it's small. So it's not enough that they're going to catch it on any sort of colonoscopy or endoscopy or any camera looking anywhere. But it's persistent enough that every eight months you kind of start running out a little bit.

Scott Benner 41:55
And stuff. Do you think supplementing could stay ahead of it? Like, should I like, double down on supplementing? And do it?

Ari R. Pelcovits, MD 42:02
Like you mean with like taking pills orally? Yes. Yeah. So it depends, it depends on the dose you're at, there's actually a point where the oral medication can kind of start backfiring if you take too much. So we used to recommend people take these like massive loads of oral iron, you know, they would take pills three times a day. And what we found was that it was it was probably confusing the body. And the body's sensors in the gut would see all this iron coming in, and would start being like, Oh, God, we must be getting too much iron. And we'd really shut things down, and it would stop working. And so that's why we now recommend you take it every day or even every other day. So there's sort of a limit to what you're gonna be able to accomplish through pills.

Scott Benner 42:43
Do you talk much about gut health? It's such a weird thing to talk about with doctors, because I feel like it's unknown, to a large extent, but absorption happens there. Right? So yeah. Are there things people can do to make their stomach a more hospitable place to absorb things?

Ari R. Pelcovits, MD 43:02
I mean, you know, I think certainly there are going to be some medications that get in the way of absorption. There are some really good doctors actually at our hospital who do a lot on sort of Gi you know, the biodiversity of your GI system and gi health. I will plead guilty that I probably don't do a good enough job like all doctors and talking about nutrition and what's going on in your gut. But but they exist out there.

Scott Benner 43:28
I'm suffering for the word, I can't come up with it. When I take a medication like keep stomach acid down, what is that? It's a something inhibitor, h2 blocker or a proton pump inhibitor, proton pump inhibitor, they also slow down iron.

Ari R. Pelcovits, MD 43:43
They do. Yeah. So there's a little bit of controversy about exactly how much but I think they certainly, again on that sort of, you've got a couple things on the scale. You know, that alone probably isn't enough to make you iron deficient. But it's certainly in combination with other things. Well,

Scott Benner 43:57
yeah, but when you're me, and they're like, Hey, take iron and take this for stomach acid. I was like, wait a minute how I know. Yeah. They gotta fight with each other. And but anyway, okay, so let's talk a little bit about how to get people help. So they have first of all, what do you see as the classic signs, signs of low iron? Losartan?

Ari R. Pelcovits, MD 44:19
Yeah, so I think there's the ones that are the most generic and then can be anything. So that's the fatigue, tired, low energy, just feeling kind of off and not not quite like yourself, but that can be 100 million different things. The one that's the most classic that we have a fun medical term for is called pica, which technically meets eating things that are sort of not foods. So the classic example in the old textbooks would be like eating dirt or clay, but the way it typically manifests is ice craving. So my wife who had low iron this was like her most classic symptoms, she would just chew and listen mounds of ice that drove me insane. And then she finally got an iron infusion once and it was like, you know, within a few weeks, she just like, suddenly one day was drinking a glass of iced water and went, Oh my God, I don't want to eat this ice anymore. Yeah. So that's almost, we have a fun word for that. pathognomonic which is, you know, if you're sitting there chowing down on ice, and you can't stop, it's almost certain that you're gonna go find your, your irons low. The problem is a lot of these other symptoms are really nonspecific. And so it takes, you know, your doctor as part of their battery of tests, including that iron level to check.

Scott Benner 45:32
So I, before I realized I had a problem with my iron, I actually bought my own icemaker because it was, I had to chew the ice. I was hydrating myself through ice, I believe. Yeah. And my hydration has gotten worse since my irons gotten better.

Ari R. Pelcovits, MD 45:51
Yeah, no, no, that's literally my wife said the exact same thing. Yeah, like, I don't drink water anymore.

Scott Benner 45:55
And then when my iron came up, not only did I not want to chew ice, but chewing ice, like turned me off. Like it almost sicken me a little bit. I was like, Oh, I don't want like, this is not a thing I would do if I wasn't getting that drive. Do you understand the? Like, what's the functionality behind that?

Ari R. Pelcovits, MD 46:13
very unclear. You know, one of these things go it's funny, right? When when we feel like something's unclear. We're okay with it if it's coming from the doctor side, but yeah, so So, so, so pretty unclear why you got this craving whether, you know, I think there's probably if I remember back to what I was taught that the thought about like, these, like clay, your dirt cravings was like you literally were trying to search out the iron there. But certainly that makes no sense with ice. So who knows?

Scott Benner 46:38
Yeah, it's I can tell you it's as real as could be, though. I know. Yeah. It was for me. Alright, so if people are having the symptoms, right, they're there, they can't get rested, no matter how much they sleep, they're weak. They are dizzy. Brain fog, chewing ice. I mean, if you please, if you're out there chewing dirt in your backyard, please give us

Ari R. Pelcovits, MD 46:59
a lot of maybe a few other things we did to work.

Scott Benner 47:01
Yeah, go see a doctor. And, but And so anyway, I go to the doctor and they run. The first thing I've learned that you have to be careful is you have to ask for a full iron panel. Is that right? And?

Ari R. Pelcovits, MD 47:13
Yeah, so there's lots of different values, there's sort of five and particularly we look at and I would say the ferritin is by far the most important. So if they're going to take check one thing, it would be the burden. But all of them together can be helpful to sort of really make sure we have a full picture.

Scott Benner 47:27
What is iron binding capacity?

Ari R. Pelcovits, MD 47:30
Yeah. So that is a way for us to measure sort of how hungry your body is for iron. So typically, when you're when your iron is low, your iron binding capacity is going to be high. So it means you know, your your capacity to have more iron, your desire for more iron is hot, you want more,

Scott Benner 47:48
okay? Because I because that always confused me. They're like your iron binding capacity is high. And I'm like, Well, hi. Seems good, don't we? Right? Right. Right, right, right.

Ari R. Pelcovits, MD 47:57
Where these things can be helpful is sort of your ferritin. Other things can impact it. And the most common thing is sort of inflammation. So some people's ferritin might be what we call falsely elevated. So it looks it looks normal, or it's even a little high. But really, they are iron deficient. And so these other numbers can help us sort of tease that

Scott Benner 48:16
out. I think that's a another thing, especially for people with auto immune, that's important for, for your doctor to understand. Because if you're sitting there at a fair ton of 25, and it may be higher than it actually is, you probably are in trouble as far as needing more. And I'll tell you, mine has been as low as seven. Like that's when I was falling over. It's seven. Yeah, yeah. The last one, I think was 13. And I was I was on my way to not doing well. But it's funny how it's almost like it's almost like driving a car and running out of gas. Meaning your tank can be completely low. But as long as the hose leading to the motor still full, you're running like everything's great. And then when it's gone, it's gone. And that's that's how I feel like I imagined if I looked back, and I very carefully looked, I might see it coming on, but it doesn't, but it comes on so creeping really slow. That is just like I'm fine. You know, I feel a little tired. And you know what, for me, it's like, why are my nails breaking? And then boom, I'm shutting off what they see the nails breaking. I'm calling the doctor like, hell do

Ari R. Pelcovits, MD 49:27
you have do you have like scheduled lab work that you do? Or is it you just wait until you're feeling this way? Yeah,

Scott Benner 49:32
so we just started talking about that. Because it looked like it was gonna you know, at one point he was very hopeful that you know, supplementing was going to be okay, but at this point now, I'm just gonna get it drawn every six months. Yeah, and see where I am at the problem ends up being his insurance. So you know, you want to be again the people say this about the American healthcare system all the time, right, like, like you want to be pre emptive but the insurance is like no, get the lab values lower and then we can do it. Right So after I feel like I'm gonna fall on my head, then we'll get right to it. Thanks a lot. But we are going to, we are trying to push them in that direction. So we'll see what happens with that.

Ari R. Pelcovits, MD 50:13
Yeah, that's good. That's what I try to do. I try to keep you know, especially people early on where I'm not sure was this sort of like a one off bleeding event or something happened that decreased your absorption, and then we're going to be fine. After we take you up. You know, let's check bloodwork every three to six months. And then we can see how you're starting to drift. You know, let's get ahead of this. Because I know how bad you felt. Let me let you get all the way down. Yeah.

Scott Benner 50:33
Oh, it is my goal not to feel that way ever again. Like I tried to stay ahead of it. Because I also don't know what else it's impacting. And yeah, there should be other stuff. And you know, you brought up I brought up earlier, like I said, like, I don't want to have a heart attack. But I am adopted, but I know very little about my birth mother. But here's something I know about her. became depressed after she was kind of forced to give me away by her family was morbidly obese after a number of maybe 1520 years and died of a heart attack trying to have bariatric surgery. Oh, God. So terrible outcome, obviously. But I just like I'm not, I am trying to avoid that, you know, and by the way, I'm not. I guess by the charts, my BMI is high enough that my insurance company was like we go over. Sure. No problem. But But visually, I don't think you'd see me that way. Yeah, and I am. So I don't know if I'm carrying it, some of it under my muscle. Like, I don't know what it is. But I just I'm not doing that. Like, I don't know, I've worked too hard to get this far. Like, I'd like to get to the end where I get to poop on like nurses in a home. And that's your goal. They have to smile and be like, It's okay, Mr. Banner, and so that they have a story to tell when they're 30. They're like, Oh, my God, I had a job when I was 18. Holy Hell, let me tell you about it. I'm trying to build resistance in the younger people already. That's but But seriously, like, I'm just trying to, you know, I've had a real, like, kind of renaissance in my thinking about age, because my mom got cancer. And she's doing well, but she got it at 79 years old. And some will argue that 79 is pretty old to begin with. But I've seen it, I saw how it kind of added 10 years to her, you know, name Yeah. Oh, yeah. And, and I just started thinking, like, you know, when we, at our age, think about living forever. I'm like, I'll probably lived on 8590 years old. But you imagine yourself as 85 now, like how you are now but that is not how it goes. And so what I told my wife is after I watched my mom with her cancer, I said, I'm going to I'm going to live like these next 15 years for the last 15 years I'm getting. And I don't imagine I'm dying at 65. I hope I don't. But I don't know where I'm going to start declining after that. And I'm like, I'm not going to just, I'm not just going to keep living now, like these other years are promised to me. But in the shape I'm in now, which by the way, I think we've just discussed for the last hour, it's not. It's not optimal. Right? So I don't know, I'm just trying to I raise my No, I

Ari R. Pelcovits, MD 53:22
think the privilege of being a doctor is that even at a young age, you get exposed to a lot of morbidity and mortality, you see a lot of people who are sick, and a lot of people die. And a lot of people who who gets to be you know, old and live well. And in it, it forces you to think about a lot of this and try to prepare yourself in different ways for that sort of, you know, outcome because I think some of it, like you're saying is, is how can I live the best I can now to be as healthy as I can at that point in my life. But the other is that, you know, it's an inevitability and not to be too depressing, but it's how do I psychologically come to terms with the fact that no matter what I do and how well I live, even if I get to 95 or 105, there's going to be a moment where my body will give up on me. And what do you do with that knowledge?

Scott Benner 54:12
I'm some days I'm stunned. I'm this old. I mean, seriously, you know? And yet, it's funny. As ridiculous as this sounds, aside of the things that I've shared here today, my vitality is like terrific. And like my mic when my iron is fine. My clarity is crazy. I am one of those people I wake up I am me from the second I opened my eyes to the second I go to sleep, like I don't know, you know what I mean? Like

Ari R. Pelcovits, MD 54:39
and you know, and I think that's the other thing that's important when you're going to the doctor and you're kind of trying to figure out you know, how to how to get worked up for these symptoms and treated you know, the other thing we sometimes do that's not great is you know, when I meet someone, this is the only time I'm ever gonna see them that are that first time is that first moment in their life. I'm meeting them and so you know, I sort of trying to make it clear what your sort of normal baseline is like you're coming in and you're saying you're sick, but I don't know what a good day is. And sort of highlighting like, no, look, I can I can be running constantly, when I'm feeling well, like this is abnormal for me. And trying to make that clear, can I think help sort of get some urgency or make people think like, well, we got to figure out what's going on. I don't want to just sort of blame this on, you know, you're just getting older or, you know, yep, some days, you know, you feel kind of down. Because I think it's easy to do that and harder to maybe think a little more and try to figure out what could be happening.

Scott Benner 55:33
Well, I'm very glad you brought this up, because it was going to be my next question. So how do people come to there? First of all, you're gonna end up at your GP first with these complaints, right? And then you're gonna see, you're gonna see the iron, or the ferritin, or the iron binding capacity, you're gonna know a little bit because you listen to this journey back. Oh, that's not right. Your GP is going to be like, that's fine. Because you don't know, or she don't know, doesn't matter. And so I tell people all the time, I'm like, stop banging your head against the wall with your general practitioner and find a hematologist. Now, it's hard to get in with a hematologist. Yeah, you know, and so don't delay. But then once I finally get in that office, what do I tell them so that we actually start moving forward from there? And I don't get ignored? Like, what would? What would really pique your interest?

Ari R. Pelcovits, MD 56:24
Yeah, so I think that what would make me convinced that we should try something is, if I can be, if I can hear that, you went from feeling good to not feeling good. So there was a change in your symptoms. And that the only thing we now can ascribe this to is this lab finding that your iron is low, or you're anemic? You know, I think what makes people sometimes they'd be hesitant is, you know, you know, I've kind of felt this way for 40 years now, certainly, it could be because your iron has been over 40 years, and nothing's happened to it. But usually, what's going to push them over the edge is that this is new, you know, in different than what I felt like before, how can I now kind of try to feel better?

Scott Benner 57:05
Yeah, I also think that there's more light bulb moments for people because of the way information is getting shared now, like, you know, because of something like this, like, somebody's gonna listen to this and be like, Oh, holy hell, I felt like Scott my whole life, I didn't know, you know, what you mean, like that is going to happen, and you have to just be able to come in to the doctor, you know, my finding is, you come in, you'll lay yourself out, you know what happened, I like to write it down. Because you can get in there and start telling stories. And that's not helpful. And the doctors looking at you, like, you got eight minutes to get to this, because I'm out of here, you know, and like, you need to be able to come in and say things, like, you know, I'm noticing this and this and this, and this and this, and then let them ask you a question. Because if you lay it out, well, then you've laid out, Hey, I think I'm anemic. Or I think my heart is low. And it's really, it's impacting me, then let them ask a couple of questions, answer them. And, and then for my money. I think you say it out loud. You say, I have been supplementing orally and it's not working. I really would like you to consider an iron fusion for me.

Ari R. Pelcovits, MD 58:19
Yeah. No, no, I think that's key. Also, sort of, if you've done the work of I've been on an iron pill for, you know, 234 or five months and look, my numbers haven't changed. This isn't working. You know, I will say there are some general practitioners who can schedule iron infusions. So we do see that sometimes. And unfortunately, probably, although I know you were just supportive of getting us over to specialists and as a hematologist, I should support that. But you know, I think you know, some more you know, well versed primary care doctors probably feel comfortable doing this themselves saying, you know, let's try the oral iron for a little bit. Let's refer you to the gastroenterologist to make sure you're not bleeding. And then you know, this isn't working let's try IV iron I can find the clinic and get get the order in for you.

Scott Benner 59:03
Oh, listen, I first of all, I would take that I would take that order from any doctor who was my dentist would write it for me I would have been like, that's cool. Let's go you know, I am I am interested by the progression though. Because I come in like and I tell you, hey, my iron bla bla bla bla bla, especially for me, this has been happening my whole life. Like, you think I've got the kind of cancer that doesn't kill you in 25 years. You know what I mean? Like, just give me a I look back on that initial situation. They could have turned me around in two weeks with an iron infusion and then gone and looked up my ass if they wanted to. But like Why leave me on death's door to do it. That I never

Ari R. Pelcovits, MD 59:48
again not knowing the specific not not not wanting to you know, totally speak speak ill of my colleagues. But I think you're right. There's no reason those things can't happen simultaneously. So if I see someone for low iron, you know, anemia And they haven't seen a gastroenterologist yet. We'll do that. But it doesn't mean I won't give them IV iron. In the meantime, well,

Scott Benner 1:00:06
I got a little I stopped seeing the the one gastro doctor because I was like, just give me an infusion. Like, I figured this out already. I tried to explain to him, I'm a very, very popular podcaster. And I've already picked I've already picked through this, and I know what's wrong. But there's part of me that thought like, hey, oh, man, I can't bill you. For an iron infusion. The way I can bill you for a scope. So like, I didn't get that feeling a little bit. I was like, Yeah,

Ari R. Pelcovits, MD 1:00:32
I think that. Luckily, for the most part, we're sort of a lot of doctors are shielded from those sort of financial outcomes. So like, for me, for instance, like, I don't get paid more if I give you IV iron or iron pills, or refer you to 10 doctors or one doctor, like I get a salary. And you know, that that's so whatever I do in my clinic doesn't matter. And more people are moving towards that. Which is by far the best on some level to avoid these sorts of conflicts of interest.

Scott Benner 1:01:00
I hope so. I hope so. Because in my mind, there's a boardroom full of guys smoking cigars going our recent murder.

Ari R. Pelcovits, MD 1:01:07
Well, listen, I'm not going to be naive, there was a lot of financial overlap in the practice of medicine that leads to some just some bad bad choices from different parties. So you know, money, money plays a big role in medicine. Let's not pretend that

Scott Benner 1:01:22
isn't the case. No, of course. And I just think from a personal level, and by the way, because the audio problems, we had your overtime, are you okay?

Ari R. Pelcovits, MD 1:01:30
Yeah, I have a patient at a lab, and I just make sure they didn't decide to come early. Well, they did. But they're okay. They haven't got.

Scott Benner 1:01:39
Alright, we'll just let them sit out there a little longer, though. Because I just wanted to ask you like one last question. Well, first, I'll say what I was gonna say, they'll ask you the question. So what I was gonna say is that, you know, all these technical things, and insurance and everything aside, like, I felt terrible, I lost a significant time and quality of my life feeling like this. So anytime, as a doctor, you're letting somebody feel like that longer than they should. It kind of sucks, you know. But So my last question is, what did I not ask you that I should have asked you about that people should be hearing about this.

Ari R. Pelcovits, MD 1:02:15
You know, I think that you sort of, I think hit it right there, which is I think the job of a doctor is to help you live longer and live better. And so I think that what you have to try to hope is that you and your physician or your you know, PA or NPU, or nurse, whoever you're seeing are on the same team to accomplish that, and aren't working against each other. I think when you have a good relationship with your practitioner, that's what it feels like. And so it shouldn't be that, you know, you're fighting against each other to kind of get to these outcomes, like you said, like losing that time. I think, on some level, part of it is I think we practice a bit of defensive medicine or, you know, we're thinking like, we don't want to cause harm. So let's avoid all these things, which which is important. But we can end up causing harm by not providing people the things they need. Yeah. Not not to leave you just to I guess, you know, I will say to just sort of err the other side of why do we maybe sometimes want to avoid IV iron and probably some of my colleagues who are a bit older than me, and I've been doing this for longer, but I have seen someone have a bad outcome, like get IV iron and actually have such a bad reaction that they needed CPR. So you can you can cut them out if you want. So if you don't want to scare your listeners, no,

Scott Benner 1:03:35
I understand why you that's why they give you the Benadryl right, because you have a reaction to it, it's gonna be a bad reaction. I gotta be honest with you, though, I was gonna need CPR and a couple more weeks anyway.

Ari R. Pelcovits, MD 1:03:45
But I will say when I when I when I saw that happen, it definitely scared me for a little bit. And I am sure that after, after experiencing that, you know, I then was probably too hesitant and giving more people iron. And I think I've now come back to a better place realizing, hey, look, that was a really rare situation. And it doesn't mean that I should be letting other people suffer because

Scott Benner 1:04:06
of Yeah, listen, I would have shoved a rusty nail under my skin. If you would have told me it would have helped. Like, that's how bad off I was. I was just like, I was lost. You know, and, and I want to be clear, not just fading, like I admitted myself to an emergency room. Like, like, I was done. I was like, This is it. Here we go. Like give me iron or like it felt like my heart was gonna stop. Like when it got low enough. It was just really I don't know how to put that feeling. But I was I'm not a panicky person. I wrote it forever. I did all the things I was supposed to do. You know, I took all the steps and I was just like, my body's shutting off.

Ari R. Pelcovits, MD 1:04:43
So I wouldn't what I'd also say, though, I guess is to add and I think we did cover this before but you know, having not everyone's gonna have that dramatic response like you did. And so I think so but I think just being ready for anything, right? Like saying like, I'm going to try this. I'm hoping it's all was my problems? And if it doesn't, the answer doesn't necessarily mean you know, give me another another dose. It means that look for what else could be causing Oh, for

Scott Benner 1:05:09
sure. I mean, if you were to get an iron infusion and nothing changed in, I'm saying six weeks, what do you think the longest is this?

Ari R. Pelcovits, MD 1:05:16
Yeah, I would say it depends on the type of irons. I don't know, if you've gotten sort of these, you know, what's called in fed this sort of big large dose at once. Or the sort of other common one we use is venofer, which is smaller doses, and you got to come like once a week for four or five weeks. I

Scott Benner 1:05:29
don't I don't play them better for bullshit. I do. I do injector for twice.

Ari R. Pelcovits, MD 1:05:35
Okay. Okay. So, so yeah, so so if you get, you know, a pretty hefty dose, but you're only needing it once or twice. And when by six weeks, you should be feeling feeling the effects of it.

Scott Benner 1:05:45
Yeah, I was once on the phone with insurance company. And they were like, We're gonna give you a benefit because it's cheaper. And I'm like, No, you're not.

Ari R. Pelcovits, MD 1:05:52
Well, right now we're actually having a problem. We're having a shortage of some of the what, in fact, is what we use, which is the big dose and so we're stuck with menopur. For a lot of people.

Scott Benner 1:05:59
I have it here in the house. It's my closet full of it. That's why I can't find any of it. But yeah, just I didn't like they I think it was like six weeks and like you want me to get an infusion six weeks in a row. And I was like, come on. Yeah, I know. I pulled out of it. But anyway, this was terrific. I can't tell you how excited I was to talk to you.

Ari R. Pelcovits, MD 1:06:22
And you know what, it's not a topic that people always are super excited about talking about. So it's great to find someone who is

Scott Benner 1:06:27
you kidding me? I'm gonna have you back someday. Amazing. I again, I can't thank you enough for doing this. I really do appreciate it.

Ari R. Pelcovits, MD 1:06:35
Yeah, no, thank you so much for having me. And thanks for everything you do. It's been it's been a huge resource for me for this new diagnosis. So Oh, my appreciate it. Oh, yeah.

Scott Benner 1:06:43
If you want to say something nice about me. You can do that at the end.

Ari R. Pelcovits, MD 1:06:46
There you go. I think I think you got it. You've helped you. Yeah, yeah.

Scott Benner 1:06:50
Hold on one second for me. Okay. Sure.

Hey, how about a huge thanks to Ari for coming on the show and sharing so much great information with us about anemia and ferritin. And thanks also to touched by type one.org. Head over there and check them out touched by type one.org 10% off your first month of therapy@betterhelp.com forward slash juice box 35% off your entire order at cozy earth.com with the offer code juice box at checkout, and a free year supply of vitamin D and five free travel packs comes with your first order of ag one from athletic greens at my link athletic greens.com forward slash juice box. Go check out the private Facebook group. Thank you so much for listening. I'll be back again very soon with another episode of The Juicebox Podcast.

#887 Blackberries to the Rescue

Liz has a son and husband with type 1 diabetes. We discuss parental pressure, seizures from low blood sugar and more.

+ Click for EPISODE TRANSCRIPT

Scott Benner 0:00
Hello friends and welcome to episode 887 of the Juicebox Podcast

this is quite an episode I'm going to be speaking with Liz. She is the mother of four children. One of them has type one diabetes. Her husband has type one diabetes, her son has a thyroid thing. And she's got a bunch of different stuff that we don't really get to until later in the episode. It's very, very interesting. I wasn't quite sure what to call this, this little ditty between me and Liz. So, even at this moment, I'm not sure what the title is gonna be. You'll find out when I do. While you're listening today, please remember that nothing you hear on the Juicebox Podcast should be considered advice, medical or otherwise, always consult a physician before making any changes to your health care plan. If you have type one diabetes, or are the caregiver of someone with type one, and you're a US resident, please consider going to T one D exchange.org. Forward slash juicebox and completing their survey. Your completed survey helps type one diabetes research to move forward. It may benefit you and it helps support the podcast T one D exchange.org. Forward slash juice box. This show is sponsored today by the glucagon that my daughter carries G voc hypo penne Find out more at G voc glucagon.com. Forward slash Juicebox Podcast is also brought to you today by the company where we get Ardens diabetes supplies. That company is called us Med and you can get started with them right now at us med.com forward slash juice box or by calling 888-721-1514 Getting your supplies does not have to be a hassle. Try us met one more sponsor today cozy earth.com My goodness, I am actually wearing oh I'm wearing at all right now I'm embarrassed I'm wearing. I'm always wearing them when I'm doing these ads. The joggers from cozy Earth and I've got the hoodie on today. They're both super soft, very comfortable. And incredibly. I don't know I'm never too hot or too cold or them. I don't know what to call that. We also have sheets from cozy Earth. And I'm thinking about maybe ordering the towels, you should check into them as well see what you think cozy earth.com All By the way, if you make a purchase while you're there, everything on the website is covered by this offer code juice box at checkout and it will save you 35% That's right, you can save 35% at checkout at cozy earth.com with the offer code juicebox.

Liz 3:05
I'm Liz and I have four kids. I live in Canada and my oldest son has type one. He was diagnosed when he was 12 months old. And he's 15 now and my husband also has type one he was diagnosed after our son was

Scott Benner 3:23
do you want to hear something? Bizarre? Yes. As we started to record which I can probably leave in you said that you played the violin. Is that right? Yeah. Yes, your husband plays trombone. And then somehow when you said you were from Canada, I was like they have music in Canada. That's it wasn't like a full thought in my head. It was just sort of like, oh, no kidding.

Liz 3:47
Level your eye level your Canadian jokes. Whenever there's a Canadian cast on.

Scott Benner 3:51
I wish I was joking.

Liz 3:55
It's, it's funny, because, you know, we, we do this new music festival every year in February. And a couple years ago, they actually had a like, it's really cold here in the winter, it gets like 30 minus 40. And so they had an outdoor concert with like ice instruments this composer had anyway written stuff for percussion with ice. And so just if you were gonna say how do you play your instruments in the ice while it has been done?

Scott Benner 4:29
I'm just gonna tell you, none of that surprises me what you just said. You know what I mean? Because when you're, I mean, if you were stuck in your freezer all day, eventually you would start making sandcastles and the ice cream. There's nothing to do. I mean, what do you like when you my brain pictured an iceberg with a person with a trombone standing on it? Do I know there are no icebergs in Canada? Sure, but that's not the problem for me.

Liz 4:54
Yeah, we're just like we're right in the middle of Canada. So yeah, no icebergs here but the rivers race.

Scott Benner 5:01
I grew up in the 80s, too. So basically, I have Bob and Doug McKenzie in my head. Right? I have ice. And then the idea that I don't know anywhere except for where I live. So in my mind you just live in a wasteland. I'm, I'm amazed. There's buildings there. What do you think of that? I just, well,

Liz 5:21
I'm I'm not from Canada. I'm from Washington state. So I'm still not used to the winter.

Scott Benner 5:27
That's the dorm. And I actually have Canada though, was honestly.

Liz 5:33
It was the most ridiculous thing is I have a cold allergy. And everyone always says that I'm just, you know, joking. But it's true. Like I have, it's this thing called cold urticaria, where I get hives and the cold.

Scott Benner 5:46
Makes it just leaving. Me I suggest leaving.

Liz 5:53
I know I should. But it's like it's where we both have our jobs. And, you know,

Scott Benner 5:58
you hear you get hives in the cold. Yeah, consistently, or is it come and go over days and over the year?

Liz 6:07
No, it's pretty consistent. I mean, I, I found out when I was in university, I was in Ottawa, and I was walking, there was this big ice storm one year and I was walking across the bridge, coming back from a concert, and so it was getting pelted on my face with these ice crystals. And then I got home and I like my whole face was broken out into hives, and I thought it was just an allergy to a new cream I had or something. Anyway, and then I was getting hives all the time. I didn't know why. And then I finally went to an allergist and he I told him that and he's like, Oh, well let me do the cold tests on you. So he held an ice cube against my skin and he's like, Yep, you're allergic to

Scott Benner 6:46
the cold. Alright, Liz, you've said so much here. We're never getting to your kid. First of all, leave it to a doctor. I'm making quotes around doctor in Canada. Right? Let me do the cold test. He holds an ice cube to the cold test. It's not a cold test. You're holding an ice cube on me. And I actually I also I was good guy. What do you got to say about that?

Liz 7:07
I was in this I was in the States I had come back. I'd come back home for the summer something winter. I can't remember Christmas vacation something So to be fair, the allergist was in in the States so

Scott Benner 7:20
you know it's funny when you tell me the allergist was in the States then I just think we've got meth head doctors all over the place. But when it happens in Canada, I think you found a guy who people just go to you don't I mean like he lives in a hut he's like He seems to know what's wrong. My bigger concern here is that you I don't think you have an allergy to the cold I think your body is just smarter than everyone else's. And it's really tell you why do we live here you have to move south.

Liz 7:47
So highly evolved? Yeah, I'm gonna go with that.

Scott Benner 7:51
Listen, that's what I would do your ever your thyroid checked.

Liz 7:56
Um, yeah, it's been a while. I think my doctor just ordered it but every time I've I've had it checked. It's been fine. But my so my son who has type one he has hyperthyroid.

Scott Benner 8:11
What would you say? Your your thyroids? Fine. What is your TSH come back? Well,

Liz 8:16
I know because so the last time I got it checked was probably before I heard all your thyroid episodes. So I do want to know for sure like this next time, I will ask her I'll be more specific.

Scott Benner 8:28
Um, say yes, I want your thyroid around to or under than I want. Yeah, outside. Again. We're gonna throw ice cubes at you and see if this urticaria comes back.

Liz 8:38
But I mean, I've never heard that with. I mean, I know there's cold sensitivities with with thyroid, but are there hives that appear?

Scott Benner 8:46
Listen, with only way I know this is because we figured out my son has Hashimotos because of hives, but it was heat.

Liz 8:54
Okay. Yeah. So you know, every once was so I would say like the first time I'm exposed to like the hot the first hot day if my skin is out, you know, like, say like my, like the upper part of my chest or my hands. I will get a little rash from the sun. So maybe I'm gonna get yours. I think I'm just sent I'm supposed to live in Washington state where it's mild and

Scott Benner 9:23
not hot. Not cold. There's no sun. Yeah, yeah, yeah. I visited once, which you might know from listening to the podcast, and it took like five days for the mountain to come out which is kind of forever cracked me up but that was the verbiage they use to describe that it was cloudy. Yeah, I think I did hear that. While the mountain comes out. I was like what are these people talking about? I used to think so when you hear me speak oddly. Couple of things. I'm from around the Philadelphia area so I miss pronounce words but Also my grandmother was Pennsylvania Dutch, which might not be something that most people understand. I don't think I've ever said this on her. But she spoke backwards is the best way I can say it. So the explanation that's very simple, is that if you had a fence, and there was an animal on the other side of the fence, a cow, and the cow needed hay, and my grandmother was going to direct you to throw the hay over the fence to the cow. She would say, throw the cow over the fence some hay. And that was just how she spoke. So I don't know why. Maybe she was only a generation removed from people speaking German. I have no Yeah,

Liz 10:44
right. Yeah, that must be. Yeah.

Scott Benner 10:47
But anyway, it's permeated how I speak. Because I speak backwards constantly. Like when I write a sentence, I finish it and then I go, Oh, the second part should have been at the beginning. It's ridiculous. Not as ridiculous as going out in the cold when your body doesn't want you to and then living in where are you in the Yukon or something? Would you say the middle of the country? No, we're

Liz 11:10
in we're in Winnipeg.

Scott Benner 11:11
I like how you said no, you're like, No, I don't live in the EU ridiculous person. I live in Winnipeg. How did you end up in Canada is this boy you met from Canada?

Liz 11:24
He is. I ended up going to Ottawa for university. I had gone to Michigan for my last year of high school. It was an arts academy that out in the middle of the woods.

Scott Benner 11:38
Just say you were smoking weed. What are you doing an Arts Academy out in the woods is that?

Liz 11:43
I mean, it was. Yeah. It's called the Interlochen Arts Academy. And it's, yeah, it's just a an art school. So there's there's a summer camp. And then there's the the academy. So I went from my last year of high school. It's basically just like, you know, violin lessons and orchestra.

Scott Benner 12:04
Yeah. And you saw his trombone. And you were like, Oh, I have to be with this person.

Liz 12:10
I didn't know. And then so I ended up going to Ottawa for university. And then from there, I I got, I just ended up getting this job in Thunder Bay, which is a super small town in northern Ontario. And then he was he was there, my he's also from Ontario. But he was there my first year of the orchestra. And then he moved to Winnipeg, and then a couple of years later, then we then we got together and then I moved to Winnipeg,

Scott Benner 12:41
was you tried so hard not to tell me something just then I don't know what it is. But it's okay. You're like, you know, and then and then he was there. But what what is it that he then did? He got me pregnant? What do we later, by the way, it sounds like a sci fi movie. You're like, I went from Winnipeg to Thunder Bay. These are not real places. They're just they can't be It's alright. Let's get past. All right. That's fine. Real quickly. You've seen this sled dog work?

Liz 13:13
I have I have actually done it in Thunder Bay. I've been missing or whatever you call it.

Scott Benner 13:23
Alright, that can't be what you call it. But we'll find out about that later.

Liz 13:26
I think it is. I think look at look it up smash. Possible. No

Scott Benner 13:29
one cares about Canada, more than me. And I've never seen it and I will never see it. Isabel's, like, are you ever gonna come to Toronto? Like no, like, god? No, you shouldn't? You should? I'm sure it's lovely. What am I gonna do? I can't get out of this house. You guys want this podcast? This is how it has to be. I die in this room with? Do you know yesterday, I contacted the hosting company who hosts the files for the podcast. So I pay somebody to keep the file. So you guys have access to them, right? And I said, Hey, if I die? How do I keep my podcast alive? And the person responded and said, in the event of your passing? Have someone contact us? And let us know that you've passed away. And we will continue to host your podcast for free. And I was like, Oh, that's very nice. Because then, you know, the protests will still be out there. And anyway, I got I don't know what happened to me. I got melancholic yesterday. And I'm like, What happens if I die? And I didn't ask Google or God I was asked the guy at Libsyn

Liz 14:40
Well, it's you know, it's a legacy either. Either way, I mean, it's Yeah, your your podcasts is amazing.

Scott Benner 14:49
Oh, thank you. So alright. I'm getting back to the trombone at some point, but not right now. So the this boy that you marry, he has type one diabetes.

Liz 14:58
He does. Yeah. So He and he was diagnosed after our son, which I feel like, probably saved his life. You know?

Scott Benner 15:08
I thought you're gonna say bait and switch. You're gonna say He tricked me into marrying him. And then he got

Liz 15:18
no, I was just gonna because he's not wanting to go to the doctor if he's feeling sick, you know, like,

Scott Benner 15:23
Oh, I see, I see you. So I think

Liz 15:25
knowing him knowing the signs is what made him figure it out. But yeah, it was bizarre. He he hadn't told me that he was even feeling off or sick. But he said that he was. I don't know, for like, the last month or so he thought that he had something really wrong. Like, I think deep down, he knew it was diabetes. But, you know, part of partly he was thinking he had cancer or something, you know, and then Excuse me. So the first I knew inkling that there was anything wrong. And so you taken a nap in the afternoon and he he got up and he's like, I think I'm gonna test my blood sugar. And I was like, okay, that's kind of weird, you know? And he said, he knew as he was waiting for the beat, you know, for the number to show up. He's like, for sure. I'm gonna have it. And I was like, 24 or something.

Scott Benner 16:15
It just seemed like it takes longer when your blood sugar's higher, doesn't it?

Liz 16:18
Yeah, yeah. It was probably, you know, one of those old meters too,

Scott Benner 16:22
right. But no, that's not actually accurate, but it feels like it like. Yeah. Okay, so wait, your son's diagnosed at 12 months? He's your man. He's your first child. Is that correct? Yeah. Okay.

Liz 16:37
Yeah. And that his Yeah. And his story. I mean, that was one of the reasons. Like he has an interesting, I guess. Interesting diagnosis story. So at four months old, he started being followed by miss my brain.

Scott Benner 17:02
Moose and squirrel.

Liz 17:05
He just literally lost all my all my words.

Scott Benner 17:08
Okay, take. Hey,

Liz 17:10
neuron, not a neurologist, but a brain surgeon. What's the thing that I need? Apparently,

Scott Benner 17:21
I know what your son has. And I feel terrible laughing right now. So now I know you're laughing at me. So the guy from let's start over the guy from Grey's Anatomy, who's married to Meredith Grey, who eventually dies in a car accident? He was a neurosurgeon. Is that correct? Yes. Neurosurgeons that sort of thing is that is was following your son since he was four months? Yes. Yes. Thank you. No problem.

Liz 17:46
Um, so anyway, yeah. Cuz his head was his head was growing at an alarming rate for a baby that four months old. And so anyway, they the diagnosis was he has hydrocephalus, and it would just extra water, extra fluid around the brain. And it's dangerous, because if, if there's a blockage and the fluid can't freely, you know, go up the spinal cord up and down, then it will create pressure on the brain. And he needed emergency surgery to get a shunt put in, and he would basically have that for life. And so it was, you know, sort of stressful having your first kid and they gave us this long list of side effects that we had to watch out for. That would clue us in that he would need to have emergency surgery. And so it was, you know, extreme fuzziness, lethargy, vomiting, all these all these things. And so, so many of them overlapped with the diabetes. So that's, that's how we missed we missed the diabetes diagnosis for as long as we did, but

Scott Benner 19:05
how long do you think you? You didn't say it?

Liz 19:08
I feel like he was he was definitely sick the month before his birthday. And then it was, it was a pretty, I mean, it was kind of probably slow at first, the decline, but then the last couple of weeks, you know, it was obvious there was really something wrong with them. But yeah, it was super stressful, because, you know, he was he was a fussy, fussy baby. And so every time he would cry, I was like, Is this his head, you know, is this and then we he also had undiagnosed food allergies. And so that was making him sort of spit up his food all the time and throw up all the time, but we didn't know that he was allergic to food. So yes, like, peanut tree nut, egg allergy, so probably when I was breastfeeding, so probably every time I was eating nuts or eggs, it was crazy. Seeing this issue in him, but yeah, anyway, so at around, I don't know, I'd say the month before his birthday, he started to get a little sick. And it was fluid like he's born in November. So it was sort of flu season cold season. And at that point he was, you know, he was a pretty happy baby, aside from, you know, bouts of bouts of fuzziness, but, you know, he was walking and not walking, but crawling, cruising along furniture, you know, holding on to stuff and, and crawling all over the place, you know, pretty active. And then, as he sort of, as he got sicker, he just basically stopped doing everything. Like he would sit on the floor. I give him some toys, and he kind of like, halfheartedly play with his toys, and he was extra fussy sleeping more. And so I was calling into his doctor's like, you know, there's something wrong with him. And he's like, Well, he has his doctor was great. Like, he was calling actually to check on him. But he was like, he has an appointment. And I think it was two weeks. So oh, okay, sorry. Let me back up. So we did bring it when he started to sort of show these signs we brought him in, and they did a CAT scan on him. And they're like, well, there's no change with the fluid. So his heads, okay, right now. Just keep a watch on them. And so we brought him home and, and then he started to get worse. And his doctor was like, well, it's flu season unless he has a fever. Don't bring him in, make sure he's getting lots of fluids, lots of fluids. So I was pushing the fluids. And of course, he was drinking at time. And like it was, it was so bad. So I would have to put him in his diet. Like for night, I would put him in his diaper, a regular diaper. And then I would put a cloth diaper and another like a cloth cover, like a waterproof cover. And he would still leak through those. But was my mom pushing lots of fluids. And I had also so I was breastfeeding still, but I was giving him formula, a little bit of formula. And then I switched to cow's milk right around

Scott Benner 22:19
with with

Liz 22:23
the formula. And then sorry, you just said very likes cow's milk. So that's why he's drinking so much. And that's why he's sweating this diaper. So anyway, so it was

Scott Benner 22:30
can you hear me? Yeah, obviously, you you've you blanked out from it. So I lost you after cow's milk. And then oh, sorry. No, don't be sorry. Okay. Cow's milk, cow's milk. Yeah,

Liz 22:42
so he was he was drinking, he was just downing these bottles. And I thought it was just he liked the cow's milk better than he liked your formula? Well, so yeah, yeah. I mean, here was still I was still breastfeeding too. But, you know, sometimes I give him the bottle formula. And but he would only, you know, anyway, so

Scott Benner 23:00
it really diapers. Before we move on? Can I can I stop to congratulate myself for a second? Earlier, I didn't ask you how often you had knots in your mouth. And I was really proud of myself. I wrote it down. I wrote down. I wrote down nuts. And they put a checkmark next to it. Like I did something good.

Liz 23:19
He needed a gold star for that. I

Scott Benner 23:20
mean, I really do. You've no idea how hard it is for me to rein in my stupidity so that we can make this whole podcast together.

Liz 23:35
I love it. You're like, before you go on, I thought you're gonna tell me to adjust my mic or something?

Scott Benner 23:41
To let you know that. Yeah. Plus, we need to break up the story a little bit because it's, um, it's a lot and I want to make sure people have time to take it in. So yeah. So hydrocephalus, the swelling on the brain, not a curable issue, right.

Liz 23:59
Yeah. So I mean, we were we were expecting that we were he was gonna have to emergency brain surgery at any moment, you know. And so we had brought him in for the CAT scan. That was fine. And then over the next two weeks, he was like, in a, like a deep dive decline. And I was calling his doctor as I should bring him in. He's like, no, no, no, just keep giving him fluids. So anyway, we woke up one morning, and he was like, just completely limp like he couldn't support himself. His legs were just floppy. And he was, he was pant. He was doing that panting breath. I was like, Okay, we have to rush him in. And as we're packing up the diaper bag, he was he just started projectile vomiting all over the place. And we're so in our, in our minds, we're like, okay, he's, he needs a surgery. And so we rushed him in. We give him the rundown of what's happening and they're like, Okay, we're calling we're assembling the team. We're assembling the surgery team. We're gonna give them another cat scan and then And then brush him into surgery. And I was like, he just had a CAT scan two weeks ago. Is there another test that we're missing? Should he have a blood test? We have to hurry that. They just kept saying the team's assembling and, and so finally, I was like, just just give him a blood test. I don't know what we were looking for. But I was like, There's something you know. And so the senior doctor came in, he's like, Okay, well, I ordered the blood tests, and it came back that he has type one diabetes, and we're gonna say his head is fine based on that last CAT scan. So we've put him on a glucose drip and an insulin drip. And this is what so they rushed him up to the, the pediatric ICU unit. And he so he was there. He was in DKA. And he was there for a couple of days. And then they switched over to the regular regular Ward

Scott Benner 25:54
was when they were assembling the Superfriends. It turns out, you were actually Superman. How about that? Yeah, I

Liz 26:00
was. I know, but I don't know what I was looking for. But I was just like, it's just so weird that two weeks ago has had this totally fine and not totally change right

Scott Benner 26:12
seem so bad in just two weeks. Gosh, I wonder what would have happened to them if they would have put him under NDA.

Liz 26:19
I know. Yeah. Exactly. I mean, yeah. Some, you know, I feel like because he was he was doing that panting thing. And they said, they were like, he was hours away from going into a coma. And so it was so scary. Like, just the thought of you know, had it been overnight. You know?

Scott Benner 26:38
No, I understand. It's Yeah, it's crazy. It really is. Okay, so do the the two issues ever. They exasperate each other. Exactly. Oh, exactly. Where's the word I want? They make each other worse, or do they not intersect diabetes in the hydrocephalus?

Liz 26:59
Oh, sorry. We cut out there for a second. But were you saying to the two shoes ever? Crossover?

Scott Benner 27:05
Yeah. Yeah, actually, listen, I'm getting a weak signal thing from you once in a while. But that's fair. Because you live in Winnipeg. So yeah,

Liz 27:14
yeah. It's probably my house sometimes. Sometimes the Wi Fi is where my house

Scott Benner 27:18
itself you think it's

Liz 27:20
yeah, like where I live in this old this neighborhood with lots of old like 100 year old houses and I don't know what they're made out of. But if I'm making a call on my cell phone, there's only a few places I can actually just call out.

Scott Benner 27:34
Okay. Stand at that place while we're talking. So yeah, do they? Well, at first you miss me. Oh my God. Now we're gonna have to start over homeless like I tried to use I tried to use a word that I know what it means, but could not pronounce. So exacerbate? Yes, yeah, that's what I was gonna say. exacerbate? How come I can say it now. Okay. Anyway, I was I reached for that word couldn't find it, then you couldn't hear me. These two do they intersect with each other ever or? No?

Liz 28:08
No, I would say so. I mean, they basically, after a year they cut us off from I mean, he released us from his care. He said the only time you would need to see me in the future is if if he gets like a head injury.

Scott Benner 28:29
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I'm gonna get you back into the show. Before I do I want to let you know that Liz's son and husband have both had seizures from low blood sugars and we're going to be speaking about them. So get ready. Nothing crazy. I just wanted to let you know. Alright, let's get back to the show.

Liz 33:02
He would have more likely a likelihood of bleeding on the brain I think if he were to get a head injury, but yeah, so his head spin his head has been fine. And two months after that was when we found out that he had all those food allergies. Right.

Scott Benner 33:18
So So is has been fine. You kicked out for a second. And oh, sorry. No, no. And I'm wondering like visually looking at him since then you don't look and see that his head appears different.

Liz 33:31
No, I mean, when he was a baby, it for sure looked large. And he feels like he would say he's, he feels like his head is big. But you know, he's definitely grown into it. It's it looks he looks normal and fine. Yeah. I think it's probably something he might be self conscious about. But with your

Scott Benner 33:57
lesson, I don't have hydrocephalus list, but my head is huge. My head is like seven and seven, eight. Sometimes I see a photo of myself and I'm like, What in the hell? You know, like, why is it so big? And meanwhile, I don't, I'm sure I mean, you know what I mean? Like seventh and seventh, eighth, seventh and eighth, like seventh and eighth is a small hat. Like it's not, you know what I mean? It's not that vector. Not that much bigger. But um, okay. So it's something he's aware of, does it impact his life at all?

Liz 34:26
No, I don't I don't think so. Okay. No, it's yeah, it's just kind of something that he had when he was a baby. And he doesn't, I wouldn't say that he puts any thought into it. No,

Scott Benner 34:34
if he would have needed the shot, would that have changed his life significantly?

Liz 34:40
I mean, it could have I mean, I think it's one of those things where they can get infected and you can you have to have them replaced later, you know, so I mean, it would have its risks for sure. I mean, I think those I think those neurosurgeons are amazing, and they probably you know, could Do those surgeries.

Scott Benner 35:03
Yes. Fascinating like me, it's such a rare thing. I looked it up when we were talking about like 200,000 people a year are diagnosed with it, which is such a small number, you know?

Liz 35:12
Yeah. And they never knew if it with him if it was him just having an overproduction of fluid or if there was actually something blocking it, but they said the only way to know would be to go in and do surgery to explore. And they, they didn't want to do that. So and it could have it could have happened just as he was developing in the womb, or it could have happened, like we had I have kind of a crazy birth with him as well. Like he ended up having forceps and it was it was a bad delivery. But so it could have been something from that or it could have just spent genetic or something.

Scott Benner 35:49
They they were still using forceps 15 years ago.

Liz 35:53
Well, the doctor that I had, apparently, I mean, he was an old school, old school OB GYN and he was he was one of the doctors that you if you had him and you had a C section it was because there was something terribly, terribly wrong like he he was one of the few people that would

Scott Benner 36:14
still use forceps I think get it out like that. Yeah.

Liz 36:17
I think because, you know, so many, like a lot of people don't do that anymore. You know, because it's, it comes with its risks. But yeah, he was apparently a gifted forcep. Doctor. That's what I heard.

Scott Benner 36:31
You imagine, but that's a hell of a Yelp review. Yeah. Okay. Again, I guess have to say to you, please just why don't you just leave Canada, there's so many, so many things, trying to tell you to leave.

Liz 36:44
I know. I did switch to midwives after that. Because I was like that was that was pretty

Scott Benner 36:48
good. Just a bear. You don't even like whatever. Like anybody except the guy with the salad tongs who's like, Don't worry, this used to work in the 40s. And it works today. Come here. Oh my gosh, are Kelly's OB had zero personality. And the take on him from everybody in town was he'll get the baby out. Everything will be fine. It's going to be a smooth procedure. But he's going to appear to be mean for nine months while you're talking. Just he was just without any kind of bedside manner at all. Yeah. Yeah.

Liz 37:25
I mean, so started, like this guy was he was super. He was abrupt as well. Like, he was this old Irish guy. And he was he was lovely. But he was just so busy. Like, he would go up north and deliver babies up, up north. And he was always just like racing from one birth to another, you know, so he, he never He wouldn't sit and like hold your hand and say How are you doing? Are you getting along, you know. But then, I look years later, we ended up having a stillbirth. And he was my he was it was considered high risk to deliver that and he he was assigned to me and during that experience it he was completely different doctor so it was very interesting to see him change. You know, like when when he needed to?

Scott Benner 38:19
What do you pay him in like jerky and maple syrup? Like, is that how that works? You're like here like send him home on his like, yeah, yeah, this snowmobile with a bunch of stuff after you like he's like rips the babies. Like, here you go. Take this joy. Oh, thank you take our maple syrupy. And then he leaves. Yeah, I know. Don't worry. I understand what's going on. Also your your healthcare system. I am mad at right now. Because I know somebody who needs a procedure. And it's it's a simple thing. And it's taking forever. And so I'm mad at Canada right now. I'm having my own personal you know, thing, right? No one knows. Yeah, but

Liz 38:57
it can take a while for sure. Yeah, interesting.

Scott Benner 38:59
Okay, so I'm so sorry. So you had your son then the stillbirth was next.

Liz 39:05
No. So I had my son and then two and a half years later, we had another boy. And then two and a half years later a girl. And then a year and a half later was our stillbirth. And then so my youngest is four years younger than my daughter.

Scott Benner 39:26
I see. I have to tell you, you really wanted more kids because that story between the hydrocephalus and the diabetes. I don't know how you did it again. Like I know.

Liz 39:36
People have said that like why did you What did you have more but honestly, you know, all the babies after him felt so easy, because there was my second baby was like, well, you're crying because you're hungry, you're tired and you're just you're not sick. So the amount of stress that was lifted after you know knowing that they're they're healthy

Scott Benner 40:00
Right. So he gets type one. In this incredible scenario, how long was he in the hospital?

Liz 40:08
I feel like it was only about three, three days or four days. I mean, he was in the, the ICU for two. And then they moved him up to the regular room. And then we had, you know, like the sort of weekend of, of training on learning everything.

Scott Benner 40:26
What did they do 15 years ago when a peg sliding scale?

Liz 40:31
No, they did talk about that. But, I mean, they kind of brushed over that. But we just we we were on MDI right away, and they put them on human log and Lantus. So, I mean, I feel lucky that they gave us that because knowing what they still are,

Scott Benner 40:50
yeah, sometimes different province could have been a different situation. Well,

Liz 40:54
yeah. And even this province, I mean, kids now being diagnosed or sometimes put on, put on

Scott Benner 41:03
what the they're still giving them like regular and mph sometimes. Yeah,

Liz 41:06
I think it's for school, school aged kids, like the younger ones, because they have no, there's no school nurses here. And there's no wait for the school staff to administer insulin. So I think that's, that's the way they think about it the way they get around it.

Unknown Speaker 41:24
Well, okay,

Liz 41:25
right. You did mention so when we switched cute, we got him onto a pump when he was five. And that was what they gave us that option. They're like, well, if, if you don't go on, I think no, I think it was like, if he's not able, if he's too young, you know, to administer the pump by himself. One thing we could do is take them off the pump and put them on this, like two shots a day. And I was like, No, we're not we're not doing that. So what we ended up doing was we started him in kindergarten a year later, so we pushed him back a year. So he would be so the thinking was like, by the time he starts grade one full days, he'll be older and more mature,

Scott Benner 42:12
able to help himself that mature Yeah, seen as the mature yet. Let me ask you.

Liz 42:20
Sometimes Sometimes not as much as he wasn't in grade one, but now he is.

Scott Benner 42:24
So what is it like raising a 12 month old with diabetes? Like what what was that like back then? I mean, how much insulin could you have possibly been giving him? It was so small.

Liz 42:37
I remember doing because we were on that they didn't have the pens. We were doing that in the syringes and right, we have the half unit syringes, but I would do I would try to ballpark quarter units all the time. You know, like, just barely pull it up. And you know, it was yeah, it was horrible. And then, I mean, the breastfeeding was good. And like it was if he was low, I remember breastfeeding him. But I was always wondering like, you know, does it give them too much? Or does he need like fed for a long time? Should I? You know, does he need insulin for that? Like it was just so? Yeah, yes. It was awful.

Scott Benner 43:22
And how did you there's just meters right. So you were testing with it? Yeah, just

Liz 43:26
meters. And yeah, he was just, I just remember him being high all the time. I remember I went in for one appointment. And I was saying, I think they must have asked like, what his blood sugar's were when he goes to bed. And I remember saying, Well, I don't feel comfortable putting him to sleep unless he's 15 or above. And they're like, well, that's a little high, you know? And it's like, well, if, if he's lower than that, he just crashes in the night. And then he's, he's really low. So it's like, I was purposely like, making him be 15 before bed. And, like, I just, I cringe when I think back like all the years of him being so high all the time for us younger.

Scott Benner 44:11
Wow. Yeah, I'm sorry, I pulled out my conversion calculator available at juicebox podcast.com. And 15 is an average blood sugar of 270.

Liz 44:21
Yeah, so that was that was what I was aiming for in the early days, just because probably he was taking like, you know, one unit of Glargine or something and it was too much or you know, his

Scott Benner 44:34
when did that begin to change?

Liz 44:37
Um I can't remember when he started using sort of a more normal amount of insulin. I mean, it was early days I remember a long time of him just being on like sick two units or two and a half units of long acting and then half units for a meal here and there and Everything is in such a blur. I feel like I've lost years of my years of my memory, either through self preservation or just lack of sleep, or I don't know. So I feel like there's details that I can't remember. But he got us he got onto a pump when he was five, and then he didn't sort of CGM until he was nine. And I don't know how we did that. Being on a pump without a CGM, like those those years were pretty awful to like, he was just like, he's always he's always been very swinging up and down, like fluctuating blood sugars, and he has to get seizures to like from the time. I'd say his first seizure was he was 18 months old, and he had sort of a handful of them in those early days.

Scott Benner 45:54
Seizures from low blood sugars. Yeah, yeah.

Liz 45:58
They would mostly happen during, like, say he had an afternoon nap. That was when he be waking up from his afternoon nap. And that's when it would happen. Like, say he'd been super active in the day and then had a nap. And then yeah, I think

Scott Benner 46:15
there's too much insulin. And then he dropped. And there's no way to know he's dropping, and I've seen a couple of seizures. They're, they're pretty frightening. So

Liz 46:24
yeah, they're horrible. They're horrible. And I feel I don't know if it's just something with how I process them. But I, I sort of, I don't know, I It's like, my brain plays the movie of them over and over in my head. You know, I think I had jumped onto one of your calls, maybe a year, almost a year ago, like you had one of those big zoom calls. Yeah. And I had just like, it had been like, a month of three seizures in our house like miles, had had to and my husband had had one like, right after my son. And so it was like, frazzled and fried. I was like, How do I stop thinking about these seizures?

Scott Benner 47:10
Well, they're frightening, because, I mean, you know, they call them low blood glucose, incidences. So I think they're trying to make it sound better for you. But I mean, it's your, you know, your brains running out of sugar. And it's, that's the, that's the, that's the fuel your brain runs on. So too much and you have all these other problems and too little, and you shut off and it's not the kind of shut off or you turn back on. So you you know, when someone's with you, they can help you and but it's hard for you, I imagine not to imagine your husband or your son being on the road or by themselves or someone doesn't notice and, and then yeah, story.

Liz 47:50
Yeah. And I think with the thing that's scary with my son is he's had a number of them where his blood sugar has been, like, say 3.6, which is not crazy low. I mean, he's, he's been much lower and not had seizures, but then he's also been lower and had seizures. So I, you know, that thing, they always say, like, trust what you know is going to happen. I feel like I can't, I can't do that. And I get so anxious. Like, just last night he was he dropped down to 2.8. And my eyes, I get super anxious if he's below a four. Because I'm like, a four going down could like, this is when he's had the seizures before. Yeah, yeah. So if I say trust, what I know is going to happen. I could like base it off of well, he's gonna have a seizure. Because that's happened before

Scott Benner 48:44

You think it's happening? Now in fairness, in fairness, are you saying 65 on a CGM, or are you finger sticking an sr 65?

Liz 48:54
Both I've done it where the CGM, you know, said so 3.6 is 65. Yeah. Yeah, so the CGM has said that but it has been on a downward trend so most likely he is below that. But then also I've done it with the fingerstick because he's been why is

Scott Benner 49:14
he falling so quickly at low numbers?

Liz 49:18
I don't I it was probably just a miscalculation on you know, maybe he sometimes he forgets to pump he forgets to enter his carbs and so he'll you know, the insulin is probably working faster than the food and or miscalculating or being more active for you know, it's it's always one of those things where it's like the little things all add up to make that perfect storm.

Scott Benner 49:47
Yeah, no, I know. But.

Liz 49:50
But he's, he's looping which I am so thankful for because I feel like it saves them so much. Last night, yeah. How's

Scott Benner 49:57
that? Sorry. That was just Oh, it's good. It's great.

Liz 49:59
You I love it. Yeah. Because last night when he he was dropping, he has basil had already cut off for an hour before. So it was sort of it's just a safety net, right?

Scott Benner 50:15
Yeah, no, I mean, it's a huge help. Obviously, it's an end if you mess up so big. I mean, listen, nothing's perfect, right, you could screw up in a way that that that the algorithm couldn't help you from, but it's, I think 99.9% of the time, it grabs Arden at the very least in the 50s, the mid 50s. As as she's trying to get low, but you know, I've seen it not be able to help to you look up and later see that, you know, it had been taking basil away for hours, and it still couldn't stop the low, which, you know, is where you have to come in, but he's 15 It's a tough age, I would imagine. You know,

Liz 50:56
yeah, I mean, he's, yeah, he's 50. He's sort of a night owl. And so we were joking. Last night, he did a carb, a carb test at two in the morning. Carb ratio test. Like, that's why that's why he went low last night. I was like, Okay, well, I guess. Thanks for that. Now. I know I need to adjust your carb ratio for two in the morning for the next time you go snacking.

Scott Benner 51:22
whole generation of kids that don't sleep. i If half my problems are that Arden is like at 11 o'clock. She's like, Oh, you know, I'm gonna have a snack. I'm like, Please, no.

Liz 51:37
I know, it's so hard. And, you know, he's, for the most part, he's just so great about, you know, doing all this stuff. And, but he just he forgets to, like, I see that rise and like, what did you eat at 345? I can see it. He's like, Oh, nothing. And then he was like, Oh, right. I had six pieces of bread.

Scott Benner 52:00
Anything on it? No, just bread. I ate it. Like I squeezed it up into a ball and then chewed on it. Great. Thanks.

Liz 52:08
Yeah, so I'll be I'll be chasing that for the next while but no, I mean, he's, he's got a lot to think about. And he's, he's, for the most part good.

Scott Benner 52:17
Doing good. Yeah. I just love that. You said six pieces of bread. I don't know why. Because part of me thinks you just randomly made a lot because it sounds ridiculous. And part of me thinks it happened.

Liz 52:27
Yeah, so that might have been like four pieces yet. I overshot that by two.

Scott Benner 52:35
Reaching into the Wonder band just pulling out Brett. Oh my gosh, how do you guys even get bread there? They must Well,

Liz 52:42
I make bread. I make bread a lot. I'm on a big sourdough kick. But yeah, we do have grocery stores.

Scott Benner 52:49
No, stop. They have staples. How did you listen to this? I have a number of questions here. First of all, do you guys make a living playing instruments?

Liz 53:01
Um, yeah. I wouldn't. I wouldn't advise for two musicians to get together. But no, it's yeah, we do. We're very lucky that we're both you know, we're doing what, what we love to do and it's it's hard to get a job in an orchestra. You know, and then the fact that we both were able to get a job in the same orchestra. It's pretty cool.

Scott Benner 53:26
Oh, wow. So you do you play regularly? Somewhere? And

Liz 53:29
Excellent. Yeah, yeah, we both play in the symphony.

Scott Benner 53:32
Gotcha. Oh, that's lovely. And when who watches these children's since you're both working at the same time in the evenings?

Liz 53:39
Well, I mean, now they're all you know, miles 15 and are older or other son is 13. And our daughter who's 10 is probably more immature than all together. So yeah, it's, it's fine. But it was, yeah, it was very expensive for the years. Yeah, yeah. Yeah. So we'd have to pay for a babysitter to come to the house and then for the daytime rehearsals and then we'd have evening rehearsals and then weekend days and we can eat so it was yeah, it was a lot.

Scott Benner 54:15
Do you have to pay a hydrocephalus tax when you get a babysitter? Are they like, Yeah, I'm gonna be pushing that up. 20% here. We're like a diabetes tax. How do you find a babysitter that can help you with a diabetic infant?

Liz 54:28
You know, it was we were pretty lucky. Like we somehow we found we found great people and I remember I remember interviewing a bunch of people. And I would go through the whole you know, because like, I have to show him how to use an EpiPen and talk about all the allergies and then you know, all the diabetes stuff and there was there was only one girl who was like, This is too much for me. I don't feel comfortable. And, you know, I I commended her for You know, being open and honest about that, because it would be a lot for, but most everybody else was like, okay, just show me what to do. And

Scott Benner 55:09
yeah, that girl yeah Mandersohn Is that correct?

Liz 55:15
Yeah, so like

yeah, no. Yeah, she came on her dog sled No. Yeah. So we yeah, we've we've had great babysitters, and we had, if you want to hear a crazy seizure start like this was, I still have huge amounts of guilt over this. So the one so our son was six, and need had sort of basically a full time nanny. That was like the full babysitter. And she was so great. Like she, she would do his sight changes, like no problem. She she had a great sense of, you know, just managing his diabetes. So we'd had her for a year and the orchestra was going out of town for three days to Ottawa. And like, we went back and forth for a long time. We're like, Can we do it? Can we do it? Maybe one of us should go and we're like, you know, she's, she's good. And we trust her and it'll be fine. And so we were everything was good. We were in Ottawa. And, excuse me, the last, the last day, we had our, our concert. So we both spoke to her backstage. And she say, oh, yeah, everything's great. You know, the kids just had a big dinner. And you know, we're just going to play and then go to bed, so everything was fine. So we turn our phones off to go on stage. You know, you can have your ringers on. We play our concert. And then both of us just forgot to turn our ringers on. And we didn't check in with her because everybody was asleep, you know, and like, we both forgot to turn our ringers on anyway. The next morning, we get a phone call from the front desk in the hotel, and they're like, we're connecting you to someone, and it was our babysitter in tears. And she's like, I've been trying to reach you all night. Miles has had a seizure. And the ambulance is here at like she was just so frantic. And so what had happened was after after the dinner, he I don't know if he'd picked up the stomach flu or if you've just eaten too much, whatever. So anyway, he had had a huge amount of insulin, huge amount of food, and then he threw it all up. And then he couldn't. He didn't want to take in any more carbs. And she couldn't get them to eat or drink anything. And how old was he there? I'm sorry. He was six. Yeah. And so. I mean, she was amazing. She gave him she's like, well, you're not eating, I need to give you this shot. So she gave him the glucagon. And she wasn't sure if it all went in or not. And, and, or maybe she just felt like she needed to take him in. So she called her dad over to watch my other son, and she drove him to the hospital. And they, they put him she's like he needs to be put on a glucose drip because he has all this insulin in him and no food. Please put them on a glucose drip. And they're like, no, no, it's fine. It's fine. There, we'll give him some gravel because he was throwing up and they're like, just, it's okay. He's good. He's stable. Just take them home and just make sure you tests blood sugar every three hours. Just like she was begging them to do something, you know. So anyway, so she, she took them home and she tested him. Luckily she tested him every she was testing like every 20 minutes or something. But by this point, she was exhausted and tired. And she woke up at five in the morning to him seizing and then she called the ambulance. And then that's that's when we got the phone call. How old was I? She was 12 I feel like she was 24 Wow. Yeah. Well, yeah. She was she was great. And then so we were we were speaking to the paramedics and they're like, well, his his blood sugar's I think six or seven or something. You six and he's stable. Do you want us to transport him to the hospital? And they're like, Well, no, I mean, he's, we feel comfortable with him home with with her there. And anyway, so we hung up the phone and we're getting in. We're like, hey, just check in with us keep testing him. So she was giving us updates, you know, and then we're getting on the plane to come back. And we're like, just checking in, we just have to turn our phones off, how's everything going? And she was freaking out. She's like, he's in another seizure. He's been seizing for 15 minutes. I don't know what to do. And she was at this point, she was frantic. And so we're like, I was asking, I'm like, have you call the ambulance and I couldn't understand anything. She was saying she was just Yeah. And so I ended up calling the ambulance from the plane in Ottawa, and then they dispatched it to Winnipeg. And they're like, Okay, we've sent it, we'd sent the ambulance and then the flight attendants are like, you have to turn off your phone. And we were wondering if Steve is going to have to get off the plane to keep talking to her anyway, so they, they actually taxied for a little bit longer and let him talk. And then they, like, you're gonna have to turn your phone off. And then they Yeah, so we had, I think an hour and a half of not knowing how he was like, knowing that he'd been in a seizure for 20 minutes and not knowing if the ambulance and anyway, so they, they were great. And they updated. They kept updating the pilot, and they would come back and say your

Scott Benner 1:01:09
list, you broke up again.

Liz 1:01:12
Using what they were able to do. I'm so

Scott Benner 1:01:14
sorry. You broke up ago,

Liz 1:01:15
they updated on guilt on that episode is is still.

Scott Benner 1:01:19
Oh, let's hold on your internet connection. They updated the pilot. I'm sorry. Yeah. And then they kept coming back then you were gone.

Liz 1:01:30
Yeah, they kept. They just kept giving us updates on the plane. So that was, that was great. I was so scary.

Scott Benner 1:01:39
Well, besides the fact that that's horrible and frightening. I'm amazed that you were able to talk them into driving an airplane around on the ground, so you can keep talking. But you couldn't talk a doctor into putting him on a like a you know what I mean? Like it's such a it's ridiculous. Like she had him at the right place. Like she No, she did the right thing. And no one

Liz 1:01:59
had Yeah, exactly. Had they just done what she had said, I mean, she was she knew she was like, this is going to happen. And she was just sort of waiting for it to happen that.

Scott Benner 1:02:10
Oh, it's terrible. Well, you made me sick. I'm nauseous now. Okay, so I can't imagine like, did you? I don't even know what to say like, did you think of just like getting off the plane? And like being like, we have to get off the plane or?

Liz 1:02:29
Well, I mean, yeah, my husband is considering just staying off the plane just to just to be able to communicate with her, you know, just but. So when when we had to turn our phones off, it was like, we knew that the ambulance was called. And it had been dispatched. So

Scott Benner 1:02:49
he was okay, after that long seizure.

Liz 1:02:52
Yeah, so Yeah, cuz he'd had the one. Earlier, he had had the one earlier and then. And based on that, because his, you know, he didn't have a CGM min. But based on the fact that he the last blood sugar reading that he had was, I don't know, like a 4.7. Before the seizure. They're like, well, we better rule out that it's, it's, there's nothing else going on besides the I mean, I was I knew it was blood sugar related those ones, but they did the EEG just to make sure there was nothing else and it was fine. And they actually just repeated that because he'd had the the seizures in the fall when his blood sugar was not super low. And they just wanted to make sure that there was nothing else. And so they just, they did that. And it was fine. It was normal. So I think there's just something with him that he drove whatever reason he can seize at a different time or a different number.

Scott Benner 1:03:52
Has he had one since he's had a CGM?

Liz 1:03:55
Yes. Yeah. Okay. Yeah. So he's had, he's had a few like, he had one. Right before I started looping the way started looping in 2019. And he'd had one and that was sort of a catalyst for me starting loop. And then he, I mean, he's had lots of near misses for sure. Like where I've caught it in time. But I could tell like, you know, how to caddy. Had I waited he would have gone into one but and then those two in the fall and I Yeah, the one was, he was napping in the afternoon. And he had had he was super emotional that day. It was the day before school started. And he'd had his I taken his computer away his laptop away for the summer. And then I gave it back to him the last day before school and then he'd forgotten his, his code to get in and he was very upset. And then I think just nervous from school and then he'd probably He just slept hard and didn't. Didn't feel it didn't wake up.

Scott Benner 1:05:05
Geez. Why did you take the laptop away? Was it porn?

Liz 1:05:11
No, but it was just just poor choices.

Scott Benner 1:05:16
Was he building a bomb? Alright, well then nothing too bad. That's fine. Wow, holy crap. I didn't know we were going here. That was that's terrible and crazy. And and so do you just have a different target? Do you target him more like 110? Or 120? Or what do you do?

Liz 1:05:38
Yeah, I have this his target at on loop, I have it 5.2 to 5.5. And then I'll often use a override that's like I call it my pasta override where I all the settings are the same, but it's up to a target of seven. So I'll throw that on if he's if he's sort of going lower eating, you know, a bunch of bread or pasta.

Scott Benner 1:06:06
I have Hold on. So first of all, for people 5.2 I was 94. Still. Okay, so you're not targeting that. Hi. And now you said I can't believe we haven't gotten to this yet. But your husband was diagnosed with type one when

Liz 1:06:23
so Myles was about. It was about 18 months after he was diagnosed.

Scott Benner 1:06:29
Okay, so he's your husband's had it for 13 years or so? Yes. Well, yeah. And he's had Yeah, sure to.

Liz 1:06:37
Yeah, he's had a couple as well. Like he had a really severe one. About a year after he was diagnosed. And then he had one just last follow like, you know, after a couple days after miles had had one so I was pretty frazzled. Have yet.

Scott Benner 1:06:59
I want to get back to you in a second. But have you gone to a doctor and been like, hi, these are the two boys in my house that keep having seizures. Can you please figure out why?

Liz 1:07:10
I mean, I think that, you know, they did check. They did check miles out, like just making sure that there was no underlying, you know, I guess epilepsy or something, but and, you know, maybe maybe it is there hydrocephalus. Maybe it's a sort of holdover from? I don't know. I mean, they never said that, that would be a possibility. But

Scott Benner 1:07:33
I'm gonna ask the question, and you're gonna take it the right way. Okay. Thank you. Is there any chance you're just bad at this?

Liz 1:07:44
Well, maybe, you know, like, when he was young, and

Scott Benner 1:07:47
well, yeah, that is a show. Like, that's for sure.

Liz 1:07:51
So, I was so bad. And I was he was always high. And like, they were happy when his agency was, you know, eight. And, you know, he's just high all the time. And yeah, I mean, we still have, we have lots of bad days, like, he's looping and he has all this great technology. But if he forgets to Bolus for something, or if his settings are a little off, I mean, he's growing so much. Like he's, like, you know, he's like, a foot taller than he was last year. Yeah, sure. Yeah. So it's like,

Scott Benner 1:08:25
it's, I don't mean bad. Like, listen, I'm assuming now somebody's gonna be mad at me. But I mean, if you listen to podcasts this long, you know what I mean? But it's, you know, like, our settings bad? Are we just flat out not bolusing for food and then making like crashing, you know, corrections later? Are we not? Are we not checking at intervals? Knowing that after we do these things, we really have to look at 90 minutes are we you know, whatever the time is for you? Like, are you just are you not doing the things that would stop you from having these problems? Or these problems just magically, like overtaking you because you're describing, what 20 years ago would have been called, like a brittle diabetic? And I don't know that that's a real thing. And that's where I'm stuck trying to talk to you about this. I'm not sure what to say like, the stories are fascinating. But I mean, I'd love for you never to have a story like this again. So I'm not certain. I mean, I'm not there, obviously. But like, how much is the way your son for example?

Liz 1:09:30
He's about 120 pounds. Okay. And it was, yeah, what he was 112 like he's taking Vyvanse for, like, add when so when he's in school, he takes the Vyvanse better over the summer. He doesn't so he's gained. He's put on some weight over the summer. Yeah, no, for sure. I mean, I feel like I never feel like I have. Like, I can never I always Feel like I'm on edge because I'm like, Well, this might happen. This might happen. I'm checking all the time. But

Scott Benner 1:10:06
oh, I'm amazed you just walked off into the wilderness like, you're, you seem kind of amazing to me. By now, it would have been like, Hey, I gotta go. You other three want to come? That's fine. But trombone and let's name are staying. I'm not taking you with me. You're like I get it. Just, it's a lot. And you're describing a situation where you must be in like, flight or fight constantly.

Liz 1:10:34
Yeah, I feel I kind of feel like I am and with, with Steve. I mean, it's he's so frustrating. Because He's so stubborn. And so old school. Like, I finally just convinced him last year to wear a CGM, and we have cub, we have great coverage. It's not the fact that we can't afford it. We have it. But he would for the longest time. He would not wear a CGM us like I'm always 4.5 I'm looking. I'm always great. I don't need a CGM. Like save it for somebody who needs it? And it's like, well, you've had a seizure. You know,

Scott Benner 1:11:10
boys? Yeah, yeah. And

Liz 1:11:13
so he and he, you know, he had had a few scares, for sure. And so anyway, he I finally convinced him to wear one. And then he's like, Oh, I guess I'm not always 4.5 Look at that.

Scott Benner 1:11:28
Lesson lesson was I test twice a day, and at the same exact times, and I'm always employed by

Liz 1:11:35
Yeah. And I mean, he did keto for about a year and a half. And he was, you know, hardly taking any insulin and, and then he told me, you know, a year after he started keto, the reason why he started keto, is because he had this big scare with, like, we were at my parents place, and there's a little mountain behind our place. And we were hiking up with the kids and Miles had had some lows on the way up. So he'd eaten all the low snacks. And then I took everybody else down. And Steve decided to go out the rest of the way with with our daughter, who was six at the time. And he he started to feel super low at the top, and he and he knew it was a bad one. And he was in his mind preparing. It's like, how do I get my daughter down the hill after I lay down and have a seizure? So he was coaching her to remember the way down, you know, you might I'm getting pretty tired, I might just need to have a rest, you know, can you remember the way down and you'll tell grandpa to come up with this track and give me a ride down thinking that you know what he would find. And so along the along the way, there's blackberries at my parents place. And so he found he found a good patch of blackberries and just started shoveling them in his mouth. And he was able to get down the hill. But he didn't tell me that for about a year. And he was like, and that's the reason why I decided to do keto because I, I just was, I didn't want this big spike of insulin. You know,

Scott Benner 1:13:16
if you try to avoid active insulin during activity, it'll help you with Lowe's. Like you know this stuff, though, like you really do listen to the podcast, right? Oh, yeah. Okay. Is there a lack of planning? Like, you mean with with Well, in that scenario, like we're

Liz 1:13:33
gonna, with Steve, I don't know what happened with him, you know, like, and I don't manage his diabetes. Like he's, he is usually really good. Like, he is on top of it, but there's always the, you know, like, maybe he had had a big piece of my mom's pie and, like, gave himself too much insulin for it, and then didn't realize that he was gonna go up the mountain, you know? Yeah, yeah. So I, I might, in my mind, I'm like, I could set you up with loop. I, you know, I have my developer's license, I could get you on. You know, I'm like, please let me do this for you. And it would take your your mental load off, but he's too stubborn. I asked him today. I was like, Can you remind me of like, the top five reasons why you don't want to go on loop? And he said,

Scott Benner 1:14:19
because I don't want to make me and you're not my mom. Back? And is he 45 years old?

Liz 1:14:30
Yeah, he's 49. Yeah.

Scott Benner 1:14:33
Hey, you. You named the kid after Miles Davis, right?

Liz 1:14:36
No, no, we didn't. Everybody always asked that. But no, we didn't really. It was just one of the few boys names we could agree on.

Scott Benner 1:14:42
No kidding. Well, that's interesting. Well, listen, you have to be stubborn to play the trombone. Because be because when you're a child, and you look at it, I mean, who looks at it and goes, that's what I'm going to do. That's what I want to do. Yeah, it's gonna be that one right there. Did he get stuck with it isn't like my story where I wanted to play the cello, but they gave me a saxophone.

Liz 1:15:05
No, I mean, he chose it. I guess he Yeah. Okay. loves it. Yeah, he's great. He's a great player,

Scott Benner 1:15:12
I imagine. Yeah. I mean, people don't pay you to play music. If you're, if you're bad at it, that's for sure.

Liz 1:15:17
Yeah. But I mean, yeah, it's, it's gotta be interesting to having, from his perspective, having diabetes, like being a professional musician, you know, because he's, he's ran into scenarios where he's on stage. And, you know, he starts to feel the drop. And he's like, somebody go get me a juice, you know, or, you know, know, and you have a big solo coming up. And, yeah, that's gonna be scary, but he is really good. Like he, for the most part, he's great. He hasn't been wearing the CGM for, let's say the last two months because our insurance they were paying for it. And then they're like, we actually need a letter of necessity from your doctor and

Scott Benner 1:15:58
podcast.

Liz 1:16:01
So he's just been lazy. And not going into get the letter from his doctor. But he's, I do want to go back onto it. Because,

Scott Benner 1:16:09
yeah, yeah. I don't know why. Oh, my God. All right. You fried my brain. So let's, let's take a break for a second. Do something fun, and then I want to ask you how you are. Okay. So here's what we're gonna do. I have a website here of the most famous female Canadians, and I'm stunned by the list. So first of all, there are people on the list who are not Canadian. So I don't know who made this list. And it's literally fit. But do you believe Rachel McAdams is the most famous Canadian female? No way, right.

Liz 1:16:46
No, I mean, she has she has a she's a current, famous actress, I would say

Scott Benner 1:16:52
being girls was a while ago. Then they have Afro Levinas, too. Okay. Her time has passed, but whatever. Now we get to a couple of people. This is fascinating. The third person is from Bulgaria, whom and then it's and then it's it says birthplace, Bulgaria. And then she's, I guess she lives in Canada, Nina dobro, or something like that. But but but not the point. You can't be a famous Canadian actress. If you were born in Bulgaria. You're a famous Bulgarian actress. No. Yeah, I agree. I agree. Then Celine Dion and Colbus molars somehow end up under they're all from Bulgaria. I don't understand that at all. This one threw me off. Shania Twain isn't from the south of the United States.

Liz 1:17:38
Yeah, I forgot that. I mean, it kind of sounds vaguely familiar, but I yeah, I thought she was from states Catherine

Scott Benner 1:17:43
O'Hare. Okay, I know, Sandra Oh, threw me off. I didn't realize she was from Ontario. Evangeline Lilly I knew was from Canada. Here's another made up word Fort Saskatchewan. that can't really be a real place. Because I noticed now I scroll I scroll I scroll. Alas, mindset. I don't know how she should be number one. I did not realize Emily VanCamp was Canadian. Now. Here's the crazy thing. Top 20 number 16. Now number 17 is Joni Mitchell. Okay, but number 16 is a porn star. How do you think Joni Mitchell feels about this list?

Liz 1:18:21
Yeah, that's not fair.

Scott Benner 1:18:22
I don't understand. I just anyway, it goes. Nothing wrong with being a porn star. But I say that I'm saying Joni Mitchell is gonna be like, I don't rank higher than pornography. Like, okay. I don't know. I'd be thrown by this. Anyone under that? I don't know. I'd be upset. I didn't know Margaret Atwood was Canadian. That's cool. All right. Anyway, here's another one. Jennifer Tilly birthplace Los Angeles, California. How does this kit

Liz 1:18:53
usually just lives in Canada

Scott Benner 1:18:55
doesn't make you I don't listen. Do you have to be born in the place? Well, I guess you could get your citizenship you know? That doesn't count you know? It doesn't count and I know it doesn't. Anyway, anyway, this this list is like a who's who of people you would not know.

Liz 1:19:16
I still think it's funny that my kids are from Winnipeg, you know? Like

Scott Benner 1:19:20
you think you actually think it's a it's crazy?

Liz 1:19:24
Yeah, it just always Yeah, throws me for a loop sometimes because I'm like, oh, yeah, my kids are Winnipeggers

Scott Benner 1:19:30
where you were born in in Washington State. Are you Canadian? Now did you do the thing where you sign up? No, I

Liz 1:19:38
need to get I need to get it. I'm just I'm just bad at doing adult things. Sometimes. It just takes me well, because I'm guess I'm just thinking about blood sugars.

Scott Benner 1:19:48
Yes. So back to you. Oh, my favorite Hannah Simone. Do you watch new girl? Yeah, yeah, I watched that was pretty sure CeCe is my favorite character on new girl followed up by I Schmidt in the early years, and then anyway, my least favorite is the main character. I'm sure she doesn't care what we Yeah, so easy Chanel, there's something about her that makes me she can you know, I'm just not just talking about new girl. We shifted off of that. I want to ask about you before we're done. Okay? Because you are in a, in a bizarre scenario like Vic, you have three other kids on top of all this. So you're a working musician, like it's not a standard nine to five job, obviously, your husband has type one, and your son has type one, and they're both prone to having seizures. And I just imagined you as like a cat in a room full of rocking chairs. Is that how you are?

Liz 1:20:52
Um, yeah, I don't know. I mean, I you know, people say to me, like, Oh, I'd be so stressed. And I am so stressed all the time. I feel like I probably should be in therapy. And I'm not but I don't know. It's It's stressful. For sure.

Scott Benner 1:21:10
Therapy, you should be drunk many hours a day was I don't want to i not i understand alcoholism is not the way to treat a problem. But you might be able to get like a some sort of a card or something like that. Seriously, I don't know that heroin is not right for you. There's like, how are you dealing in reality all the time?

Liz 1:21:32
Well, I don't know, actually. And, you know, poor, poor miles. Like he has all the stuff and the other kids don't have anything. I mean, they had a little bit of like viral induced asthma, all of them, at one point needed a inhaler when they get a cold. But it's not like they have to use it all the time. But he has, you know, he gets the diabetes and the severe food allergies and the thyroid, and

Scott Benner 1:21:59
so you don't get to think about yourself because they have worse situations than you.

Liz 1:22:06
Oh, yeah, I turned it away from me, didn't they? Yeah, I just I yeah, I guess I'm just focused, focused on them and trying to keep the peace. You know, like the kids. Just for them. They sometimes will fight and just trying to keep things calm. But

Scott Benner 1:22:24
because you're so not asked, answering my question.

Liz 1:22:29
I just, I don't know. I don't know how to manage it. Really? Because I guess.

Scott Benner 1:22:34
So is the answer that you're not? Or you're just like,

Liz 1:22:39
Yeah, I mean, I do feel frazzled and tired all the time. You know, like loop definitely helps me get more sleep than I did before. Like, before I was a complete basket case. I feel like, and I do. I do feel like I joke about it. But I do feel like there. I've missed I'm missing parts of my memory. Because I like, I'll be having conversations with people and they bring up something that I've said before happened, or people I've met, and I like literally no recollection of it. And I always feel I always feel bad when I'm talking to somebody. I'm trying desperately to remember details, because I don't want to seem like I'm, you know, not caring about what people say. But then I feel bad if I don't remember things or like, and literally like I you know that face blank. You hear people say they have face blindness? Where? Yes, they just think yeah, I don't know if it's some something I have like maybe a little bit of that or like I'll be I'll be I'll meet somebody at a gathering. And I'll have a full conversation with them. And I'll be talking to them for I mean, it could be half an hour or an hour. And then if I need them. I don't know I meet them six months later, and I have I would be like, Oh, hi. How are you? You know, like, was nice to meet you. Like they're like, we've had we've talked?

Scott Benner 1:24:07
Do you really think is is it possible? You have that? How do they diagnose it's called I just feel like I'm sleep deprived. Okay, so you just exhausted? I think so. Do you how much do you sleep?

Liz 1:24:21
Um, well, I don't know. I mean, I, I try to go I usually tend to fall asleep around midnight, but then, because I like to sort of see what's happening, like, what his last snack is going to do or whatever and then, or I'll hear him up at midnight and I'm like, Oh, he's gonna eat something. So I have to sort of be on extra alert. And then I you know, I have my alarms and alert.

Scott Benner 1:24:50
So, Liz, I'm stalking you online right now.

Liz 1:24:53
Here's something I wake up and check it a couple times a night.

Scott Benner 1:24:57
Okay, hold on you. You blipped out at this The craziest moment so I didn't hear oh, sorry. No. Wait, do you hear what I said? You use headphones. No, no, it's not your internet connection. I get a I get a signal here internet connection gets bad, but so you're staying up later at night checking on him. And then I didn't kind of get the rest of it.

Liz 1:25:20
Oh, yeah, I just I think I have trained myself to even if, even if I think he's going to be steady, I just trained myself to wake up and check it anyway. So I check it a few times. And it's great. You know, I have I have the loop on I charge his watch next to me. So if I have to give him insulin or put an override on I can do that from my bed. I don't have to get up.

Scott Benner 1:25:42
Right. But you're getting a lot of broken sleep. Yeah, I think so. Yeah. Very bad for you. Okay, so what I was gonna say is what I did say when you couldn't hear me, which was wide felt creepy, is that I'm stalking you online at the moment. And so you're, you're a thin person. Is that right? Yeah, but when you were married, you were thin but not that thin. Not as thin as you are now. So are you like, lizard? So? I've always been thin. Okay, maybe it's just a photo. You're like, oh, I looked fat at my wedding. Great. Is that what you're saying? It's not what I'm saying. You looked more like a youthful, like, I don't know what to say. Yeah. Adorable. But

Liz 1:26:21
the bitterness wasn't there.

Scott Benner 1:26:27
What's your mouth seeing Scott? Balding a trade of life?

Sorry. Now we're getting to it. Liz. So, are you so I was just gonna say are you naturally like lean? Or are you out of your mind? Thin? Do you know what I mean? By the two things?

Liz 1:26:52
Yeah, no, I yeah, I feel like I'm just not like, yeah, naturally lean,

Scott Benner 1:26:58
okay, because there's a thing that happens like, like, like, there are some stressed out people are sometimes either really thin or heavy. Like they go in one way or the other. Right? Like they eat a lot because of the stress or they don't eat anything because of the stress. Right? But you would

Liz 1:27:13
start I started taking I have like chronic migraines and stuff. So I've been taking this medication for the last little while and they've they've upped it. I didn't notice anything for the first nine months when I was taking it. And one of the side effects is weight gain, but I didn't notice anything until they just upped my dose recently and I have I think gained about six pounds.

Scott Benner 1:27:36
Okay, well, what does that make you? 91 pounds? Like? Yeah, okay, so you're not gonna get any compassion out of me on that one? Listen. If I lost six pounds, you'd look at me go Scott looks exactly the same. But But okay, so being like being serious, if I can be I don't know, because you really cracked me up with a bitterness statement. Like, that's amazing. You're Are you not okay, but you're just telling yourself you're okay. Like, are you willing yourself to go on? Or do you actually think, like, Is there is there going to be a moment your life when you look back and go, I wish I would have taken care of myself differently.

Liz 1:28:19
Yeah, maybe? I mean, I, yeah, some days I feel like that for sure. Other days, I feel fine. And I'm just sort of, you know, going along, things are fine. And then other days, I feel like Yeah, super stressed out. I mean, I mean, my my job is like, our job is kind of stressful as well, like I you know, we're not working right now. But we'll start back up again in September. And it's kind of a high stress situation, you know, like, preparing music that has to be, you know, at a concert level and,

Scott Benner 1:28:55
and then doing it how many times a day once you're working?

Liz 1:28:59
Um, yeah, it depends on what what kind of concert we're doing. But yeah, we'll have we'll have a few rehearsals and then the concert and then probably yeah, sometimes it's like two programs a week like different music that we have to prepare. Can you

Scott Benner 1:29:14
enjoy it playing the music? Or does it feel like work?

Liz 1:29:19
Yes, and no, I mean, I feel I'm always in pain when I play. I mean, I there might be something I feel like there might be something going on with me and I just haven't figured it out. Like I'm in constant pain when I play. So I don't enjoy it as much as I know I would if I wasn't in pain, your joints muscles so much my joints and muscles might like I have I'm, I have one leg that's I've one leg that's a little bit longer than the other one. And then I have a little bit of scoliosis as well. So I feel like I'm and then playing violin is so you know, it's not very good than that. What it's all it's all cricket like you're over developing and using. Anyway, so I probably Yeah, it's probably just a posture and muscle thing. But even if I take, say I take three months off or two months off, which doesn't happen very often, but if I, you know pain almost, you know, it's, it's more when I play but

Scott Benner 1:30:30
so when you take time off because you've looked out for a second when you take time off the pain kind of lessons a little bit, but it's still there. It's still there. I've never like it's very infrequently that I think this but you should probably smoke weed. Like I probably should. Yeah, of all the people I've talked to in the last 30 days, I'm putting you at the top of my Canadian, not Canadian ladies who should smoke weed list. Yeah. So and you've gotten me so relaxed. Now. I like you so much that when you said I have one leg longer than the other?

Liz 1:31:05
Can I make so much fun? I have

Scott Benner 1:31:07
scoliosis I thought to say braggart because my like my real sarcasm is like it's bubbling to the top now. Like, I give you guys like 8% of my sarcasm, because I don't even believe you would like me if you heard it all. So I just had an incredibly sarcastic thoughts all the time, which I then distill down and try to turn it into thoughts while I'm talking on the podcast. But Oh, listen to her bragging. Yeah.

Yeah, I don't know, I'm worried for you. I know.

Liz 1:31:46
Part of me thinks I'm like, maybe I have fibromyalgia because I'm always tired. And I'm always sore. And why would

Scott Benner 1:31:52
I write first about that? Yeah. Right. I mean, especially if your son has hypothyroidism and there's autoimmune in your family. I know your husband has type one, and so does your and so does your son. But that doesn't mean that it can't be something on your end it also, you know, you're so used to looking for people being sick. Because of your scenario, I find myself in this sometimes if something happens in the house, I'm like, that's probably definitely a rare type of blah, blah, blah, because you're just used to things like that happening. And then sometimes it's like, oh, no, that's not it. I just have a cold, like, you know, like, and so, I mean, like, because you're like, I might have fibromyalgia, you also might have scoliosis, and just be uncomfortable, because you're contorting yourself playing a violin, right? So, and you're getting older, and you're under a ton of stress, and you're not sleeping. Right. So I don't know, what would happen if you just like took off for days and slept?

Liz 1:32:47
Yeah, I don't know, either. I think I would, I would just, I would get more stressed out. Just giving all the control over, you know, like, I would I would be worried that something would happen? My answer would be no.

Scott Benner 1:33:06
Is there a control thing going on?

Liz 1:33:09
Well, though, I mean, yeah, I realized that how that sounded. I mean, maybe like

Scott Benner 1:33:13
he realized how it sounds. It sounds like what you said. Yeah. So, I mean, it sounds like you're being very honest. For a second. You don't want to troll? I don't know, your family safety to be out of your hands.

Liz 1:33:28
Yeah, I feel like it would just stress me out. Giving all the all the burden to Steve to to handle. And then, you know, after, after that thing that happened when he was six, when we went to auto we for sure could I mean, Steve would love to go away just the two of us. But I was like, that's never going to happen again.

Scott Benner 1:33:52
Well, it will someday.

Liz 1:33:55
Yeah, I don't know. So we're actually we're waiting to hear any day. We should hear if he's going to be approved for alert dog. So

Scott Benner 1:34:05
your son or your husband?

Liz 1:34:07
Our son? Yeah. Yeah, so we started the process three years ago before COVID And then it's just sort of sort of finally wrapping up now to see if he gets it but

Scott Benner 1:34:21
yeah, so listen, you need proof of all that you remember the Jackson juice they put Michael Jackson to sleep with that's what you need. You need to go night night for like a while like, I know this is not legal, but it's you need you need.

Liz 1:34:40
A couple years ago, I needed I needed surgery. It was like

Scott Benner 1:34:44
best day your life. Yeah. Like a

Liz 1:34:47
hernia, like you know, leftover stuff from like muscles separating from the birth and stuff and I was joking with the nurse after I was like, can you just can you give me extra so I stay asleep for a long time because I never get to sleep at home. No kidding. I mean, they actually did. Did they really? Yeah. They're like, yeah, we felt sorry for you. So because I

Scott Benner 1:35:10
left you out a little longer.

Liz 1:35:13
Yeah, I was, at one point, I was like, you know, I woken up and and I was sick. So what, what sort of time and they'd left me there, I was there all day sleeping, like kind of just come pick me up and they're like, Oh, you can go home anytime we just, you know, just wanted you to.

Scott Benner 1:35:33
Please let me tell you, you've painted a picture today of a health care system in shambles in Canada. You've you by the way, if you ever get divorced, there's no way anyone who hears this is going to marry you. So you're not gonna be able to get

Liz 1:35:45
that one leg longer. I'm super stressed out.

Scott Benner 1:35:48
I remember, I'm waiting for when you're like, my vagina is actually on my thigh. And I don't know. It's just Yeah, it's sort of like midway between my knee and my hip. It's sort of on the outside. I don't know why it's there. Like you, but but still, I'm more focused on you not sleeping.

Liz 1:36:06
Yeah, I mean, it is

Scott Benner 1:36:07
a big deal.

Liz 1:36:08
It is. For sure. Better with loop. But yeah, I it is it's just hard. You know, like the, the last time that Steve had a seizure, it was in the middle of the night. And that time, I mean, I still I feel guilty about that, because he was actually high. He was wearing a CGM at that point. And he was super high before bed. And he had given Can you hear me?

Scott Benner 1:36:33
Oh, yeah, I'm listening. Sorry.

Liz 1:36:36
He had given himself a big correction. And, or I just figured a normal correction, actually. But I had told myself, I was like, I'm going to be hearing his high alarm for the next couple hours. And I psych myself, I'm like, don't listen to the ill I was telling myself don't listen to the alarms is just as high alarms. Because I was trying to, you know, just tune it out. And then it was actually his low alarm was going off. And I wasn't listening to it. Because I in my, my brain had switched it around thinking that he was just Hi.

Scott Benner 1:37:08
Any people in your life pass away, that you feel any kind of attachment to?

Liz 1:37:17
Um, no, I mean, I've had a floss gram, but but I haven't. Like, I haven't had any sort of tragic losses like that

Scott Benner 1:37:27
your guilt is like is, I understand it, like, don't get me wrong, like, I get where it comes from, and I understand why you have it, and I understand why you're worried and why you feel like you can't sleep, but it's so untenable. You know, like, is there any way you could talk yourself into it that way, like, you're not going to be around as long as you want to be for these people. I mean, not to say you'd be dead, but you might be so like, useless was the word I was gonna lose. Like, you might just, you might SAP yourself down to the point where you can't be helpful to them. And then that's going to make you feel bad. Like you're gonna have to, like, do something for yourself. And then now to get to the later if that makes sense.

Liz 1:38:12
Yeah, yeah, you're right. Yeah, for sure.

Scott Benner 1:38:14
Because this went in so many directions. Do you didn't expect this? I imagine.

Liz 1:38:19
I didn't know what to expect. I mean, I knew Yeah, I I guess I was nervous about you know, making sure that it was I had something of value to say, you know,

Scott Benner 1:38:32
well, you definitely do.

Liz 1:38:36
Yeah, cuz I get so much out of the podcast and if it's even if it's something that is not relate, not related at all, to my situation, I there's always some sort of nugget in there. That's helpful. But

Scott Benner 1:38:51
well, that's great. I'm glad I this is my favorite part of the podcast, and somebody says something nice about me, so I didn't want to didn't want to talk over you while you're talking. Like, keep going. And, and what else did I do?

Liz 1:39:05
Yeah, no, I, I really, I love I wish I you know, I'm so happy when I hear people that find you and the group and the podcast, you know, like, even when they're in the hospital, you know, or within the first couple of months or the first year even or it's just I I so wished that I could have had what you what you provide to people when he was first diagnosed, because I feel like it would have things would have been so different. And I mean, he's, he's doing great now like he has, you know, he has ups and downs and roller coaster days, but like he he's not having tons of lows right now. He's at like 1% Lowe's. And he's his last two agencies were like 5.7 and 5.9. So and he's been in the sixes for for a long time, but Um, yeah, there were definitely like, years when I just didn't know, having a a Wednesday, if eight was a bad thing you know,

Scott Benner 1:40:13
was, here's what I want for you. And I hope you'll listen. Yeah, set everybody's target at 120. And, like on a Friday afternoon, disappear into a room with like, blinds that go dark and just like sleep the weekend away. And just try to get yourself like, rested. And take five minutes to go to the doctor and get yourself a, you know, a checkup, have them run some blood work, tell them everything that you've been feeling. See if they can find out something simple. Tell them your kid has hypothyroidism you want your, your your thyroid levels checked, get your iron checked, like do all those little things that you know we don't do for ourselves. You could be tired from I mean, you're a menstruating age woman you could you could have low iron. You could have hypothyroidism yourself, you might not. There are just some simple things you could do to help yourself like I just feel like you're you're existing and you're not taking care of yourself at all. Yeah, am I right?

Liz 1:41:24
Yeah, there's definitely interest in there and yeah, yeah, you're right. Yeah,

Scott Benner 1:41:31
just take just take a weekend, like look at them and go, I am trusting the two of you not to kill yourselves or each other. And by the way, take care of these other three. Actually, if I was you, I'd put the other three in charge of those two, but I mean, you know, yeah. And. And your husband and your son. They're very much like the type ones.

Liz 1:41:52
Yes, yeah. They're, and they

Scott Benner 1:42:01
and they disappeared less.

Liz 1:42:03
And I think probably they're both too stubborn to admit that.

Scott Benner 1:42:08
Gotcha. Okay, so they even look alike, don't they?

Liz 1:42:12
Oh, sorry. You just cut out for a second. Oh, actually, you cut out

Scott Benner 1:42:15
but they're back. Yeah, no. So I asked if they were like you said they're both both stubborn. And I just that they kind of look alike, too, don't they?

Liz 1:42:25
Um, I'm kinda I mean. Yeah, all the boys. All the boys have red hair, like various shades of red hair. And Steve has like dark. I say it's black. He says this brown. Right.

Scott Benner 1:42:38
Oh, it's a lovely family. You have I would like you to get some sleep so you can see it and remember their faces a couple of weeks. You ever forget the kids names? Oh, I,

Liz 1:42:49
I mean, I know their names. But I always start all of you know if I'm saying I'm trying to save Felix, I'll go through the first syllables of everybody else's name. So it's like, we have miles Felix, Hazel and Quincy so I'll be like, hey, my Felix or fie. My Hazel.

Scott Benner 1:43:09
Yeah, this are you and your husband about the same age?

Liz 1:43:12
He's four years older.

Scott Benner 1:43:15
Okay, yeah, you're too young to not remember everybody's name. You're exhausted. Yeah. And you don't know it?

Liz 1:43:23
Oh, I to know, I

Scott Benner 1:43:24
know. But I mean, like, you don't know it enough to be like, I have to stop. You like you're like I'm exhausted. But look at me. I'm doing it. You know what I mean? Like, I used to be like that. I used to have that. Like, oh, I'm handling this. Like I'm handling sleeping four hours a night. I was not handling it. I just lied to myself and told myself I was. So I don't know it, just please take care of yourself. We're never going to talk after this list. So I'm going to worry about you. I'm going to be like this right now. I feel like I'm on the plane. And they're telling me we're going to take off and I'm like, I gotta shut my phone off. And I'm not going to find out if Liz does, okay. I mean, I'm worried I'm not. I know, it's, I don't want you to feel bad because we've only known each other for an hour and a half. And my takeaway is, this is gonna die, and I gotta do something. But I really want you to do something for yourself. I hope you do.

Liz 1:44:13
Oh, thanks. That's nice. Well, maybe maybe in a year or something. Steve will come on the podcast. And by that time, he'll be able to report that. He's looping. And he's wearing a CGM. And I'm sleeping.

Scott Benner 1:44:28
Yeah. Well, that would be that would be lovely. And I'd like to hear that story about him walking up the hill, because that almost made me cry when you were talking about that.

Liz 1:44:36
Yeah, I think that's why he didn't tell me for so long because he had a really scared him. Yeah,

Scott Benner 1:44:41
no kidding. I would imagine. All right, well, I appreciate this. I'm sorry. I kept you much longer than I said I was going to but Oh, that's okay.

Liz 1:44:47
No, thank you for letting me ramble on. Sorry.

Scott Benner 1:44:51
You didn't ramble. You were good. Don't worry. You were very good. I have an episode that anyway, I'll Tell you what, let's stop it. I'll tell you in a second

A huge thank you to one of today's sponsors, G voc glucagon, find out more about Chivo Capo pen at G Vogue glucagon.com Ford slash juice box, you spell that GVOKEGLUC AG o n.com forward slash juicebox. I also want to thank cozy Earth and remind you that you can get 35% off at cozy earth.com with the offer code juice box at checkout. And of course us med us med.com forward slash juice box or call 888721151 for art and gets her Dexcom and Omni pod supplies from us med you could too they also have tandem and Lee brain go check them out. I want to thank you so much for listening. I'll be back very soon with another episode of The Juicebox Podcast. Don't forget to subscribe and follow in an audio app like Apple podcasts Spotify, Amazon music anywhere where you get your audio find the show hit subscribe or follow depends some apps ask you to subscribe some say follow whichever your says that's what you do.