Monthly Archives: September 2013

Kato san

I want to introduce you to a new acquaintance of mine.

During the very recent three-day weekend in Japan, my husband, I and a couple of friends stayed at an old Japanese farmhouse in Niigata. Our host was a Japanese man called Mr. Kato. Kato san is a crazy (in a really good way), lively, open, enthusiastic, and sociable man who does not seem to have an ounce of ego, arrogance, insecurity or machismo in him. His surname Kato is actually his wife’s surname, which he adopted when they married. That’s not unheard of in Japan, but not that common either (at least I don’t think so). He has had different jobs, all people-oriented. In the short time we stayed with him, I could tell that he loved people.

Mr. Kato and his London cab

He now works as a cab driver in Tokyo. What’s more interesting is that his own car is a 40-plus year old black London taxi cab, which he used to take us around to see the sights in his neighborhood and town. He loves fishing, among a host of other hobbies. He can out-talk any Japanese or non-Japanese person I know, and is prone to outbursts of infectious belly laughs. He is happy to share family photos and stories (family members were unfortunately elsewhere working), experiences, and adventures. He also has an appetite for learning, and is genuinely interested in people (in case I haven’t mentioned this trait yet).

He has also been diagnosed with pre-diabetes (and the first one I’ve met in Japan). He volunteered the information when he saw that he and I were taking the same brand of metformin. He was quite nonchalant about it. Come to think of it, the few Japanese Type 2 diabetics I’ve met since I was diagnosed were all relaxed about their diagnosis. I do not mean that they don’t care. I mean they do not hyperventilate about it and assume that the world revolves around them and their diabetes. I don’t know if it’s because they were older when they were diagnosed, and so have a better perspective about life’s challenges, or it’s their culture.

Anyway, Kato san and I shared information, from our A1cs at diagnosis to current A1cs, to what foods we had to reduce or avoid, to what foods we miss (beer and ramen shared the top spot), and what foods we absolutely refuse to give up (both of us named chocolate and ice cream). We shared secrets over what alternatives we may have to high-carbohydrate commercial simple carbs. He has lost close to 8 kilograms since his diagnosis. He shared both his worries over possible complications and his bottomless optimism for the best. He may be pre-diabetic but he considers himself fully diabetic for all intents and purposes.

We shared information. I want to stress the word “share”. We did not try to outshine each other. We did not judge each other. We did not lecture each other. Also, we did not spend too much time talking about our diabetes. We spent more time talking about other things.

It was a relief to be able to exchange thoughts, fears and yes complaints to another person who not only empathizes but knows what I’m talking about. It was equally refreshing to not have to talk about diabetes and food all the time (one reason why I have reduced my presence in diabetes online boards). And I would not have had that opportunity had I kept my diabetes only to myself.

When I was diagnosed, I told only a handful of people, and I tested my BG and took my medications very discreetly. It took me a long time to start opening up, and testing and taking my meds in public. I do not make a big deal of my condition, but neither do I hide it anymore. I’ve even started blogging and tweeting about it. Not only is openness liberating, but it has created opportunities for me to meet and interact with fellow diabetics, both in the flesh and online, and be part of a larger family. The knowledge, support and energy one gets from others who have similar experiences and who can offer their hard-earned lessons to save us from highs, hypos, and other diabetes-related mistakes they have gone through, cannot be matched. More than that, being part of a community is empowering as one sees the potentials of concerted efforts. Take the Strip Safely campaign for example. That’s a good representation of channeling our frustrations to something more productive than just complaining.

I would not have met all the wonderful diabetics in Japan that I’ve met (although they are just about a handful of people at the moment), and outside Japan as well, not just through online boards but through blogs (see my blog roll) and websites, or in person, had I been content to keep to myself.

I do recognize, however, that being open about your diabetes may not all be good, as it invites the food police, judgment, unsolicited advice, and even threat to your job. But I think that these problems can be dealt with by choosing who you reveal your diabetes to, timing, and not making a fuss over it. I do not advice disclosing your diagnosis the second you hear it from your doctor. I think that you need to find your way and have a clearer picture of how you will approach diabetes, before you throw yourselves to a larger circle of people who each has his own views, beliefs and prejudices. But, it is not a healthy choice to keep everything to yourself. At some point, you need to let people know, lest you explode like an over pumped balloon.

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Apples and chocolates

Memories have a funny way of popping up when you least expect them and without provocation. While I was out running Saturday morning, the name of a college friend, Tonette, and a brief conversation we had more than a decade ago came to mind. We had both been living in Japan for at least two years by the time we had our little chat. I was here for work, while she was here earning her PhD in engineering.

A few months before Tonette completed her doctoral thesis and went back home, she came over to my place to be my food tester (I was just learning how to cook and she agreed to share my table – one brave woman). She brought a box of strawberries, which led me to comment on how expensive fruits and vegetables were in Japan. Our conversation went something like this:

Me:  Thanks for the strawberries. I still can’t get over how expensive vegetables and fruits are.

Tonette: True. Which ones do you often buy?

Me: I don’t buy much. Too pricey.

Tonette: Do you buy chocolates? 

Me: Yes I buy chocolates, but now I’m trying to cut down on chocolates.  

Tonette: How much is an apple?

Me: Between 150 yen and 200 yen depending on the season.

Tonette: Do you find that expensive?

Me: Yes.

Tonette: How much is that bar of milk chocolate sitting on the table?

Me: That brand is about 150 yen.

Tonette: Do you find that expensive?

Me: I don’t think so. Actually, I never thought about it.

Tonette: We usually complain about the price of fruits and veggies but not the price of chocolates. And we buy more chocolates and potato chips than we do apples. Why is that?

Yes, why was that? 

I’d like to say it’s finances, that apples are more expensive than chocolates and potato chips. But it really is a question of value and choice. At that time, I placed more value on chocolate (and milk chocolate at that) than I did on fruits and vegetables, and my distorted sense of food value dictated most of my food choices. I didn’t consider the fact that cheap milk chocolate provides short-term enjoyment for a lot of calories, while an apple (also sweet and can just as easily ease a sweet tooth) is also enjoyable, has fiber and is more filling, has fewer calories, and has vitamins and nutrients that a bar of milk chocolate does not have. Looking back, I also remember getting all excited about going to buffets, because I thought that I was getting a lot of value for my money. But plates of mediocre food, gallons of soda, and tons of calories, not to mention an aching stomach, later, one had to ask whether that really was good value at all. For the same price, can a mountain of forgettable food really trump a much smaller meal of wonderfully cooked food? More than ten years ago, I would have said yes.

Quality food usually costs more than commercially manufactured meals, which makes it tempting to grab frozen dinner or a doughnut. We are not all financially well off and most of us live on a budget. This, however, does not mean having to sacrifice real value in favor of cheap imitation, at least not most of the time. But we have to do some research on where we can find cheaper ingredients, do our homework on what healthy meals we can prepare, and learn to cook, with the aim of minimizing our reliance on processed food, and fast food diners and chain restaurants, while keeping within whatever financial limits we may have. For example, my husband and I have no qualms at looking at the “has been” bin and buying a cheap bruised or warped zucchini instead of its “perfect” but more expensive brother. We can also be more adventurous in trying unfamiliar animal parts or vegetables, as many of them can be cheaper than the usual fare. In the process, we help minimize food waste (but that’s another topic).

What many of us may not be aware of is that we may not need so much food to be satiated. From my experience and those of people I know, good quality food is usually more gratifying (taste-wise and nutrition-wise) than processed food, such that you don’t need to stuff yourself to the gills to be satisfied.

Paying attention to quality food also translates to better health, which in the long run is where true savings lie. It is false economy to eat cheap commercialized products that are terribly lacking in nutritional substance in the hope of saving a few dollars (or yen, in my case), only to have to shell out more later on for doctors, hospitals and medications to deal with failing health and nutritional deficiencies. Plus, who wants to spend most of their later years unable to go anywhere or enjoy life because of bad health?

By the way, I remain a chocoholic, but a reformed one (yes, that’s not impossible). Only, I no longer eat cheap milk chocolates. I now only go for 75% (or higher) chocolate, for at least three reasons. First, it’s so rich and filling that I don’t go through a bar in one sitting anymore. Second, it’s more expensive, so I make a bar last. Third, it’s chocolate, so I get my fix. My weight stays the same, my taste buds are happy, and I get my chocolate-induced endorphins with just a small piece of good quality dark chocolate.

Quantity, not quality, has become the standard of value for one’s money. Let’s try to flip that and instead focus on quality, not quantity. Quality eating takes time and effort, and may test our budgetary limitations, but our health and that of our family, quality of life, and in the long run our bank accounts, will be grateful for it.

Six Years of Living with T2D

I had my regular check-up with my endocrinologist this morning. Last week, I had a fasting blood test, and today we met to talk about the results. Before talking about the results, however, I tried to convince my endo to minimize fasting blood tests (I don’t like skipping breakfast, even if it’s just once every three months), but he likes to check my cholesterol level and other conditions that require a fasting blood test. I tried before but he gave in only one time, with the excuse that he wanted to know what my two-hour post-breakfast BG level and non-fasting cholesterol level were like. Just once. Today, I don’t think I convinced him to do away with fasting tests.

Anyway, my appointment with him was uneventful as everything was absolutely fine. How exciting is that? But, to my endo’s credit, what could have ended in five minutes was extended to more than half an hour, as he spent time to explain one of the tests, my fasting insulin level. He was pleased that my fasting insulin, my fasting BG (mind you, after showering, dressing up and going to the doctor’s office) and A1c were within the normal range (some, on the low end). If it weren’t for the fact that my previous tests consistently showed that I’m T2D, I could have been diagnosed with another type of diabetes.

My endo again brought up the possibility of reducing my metformin. I’m on 1,000 mg of metformin and he wants to reduce it to 750 mg. I had to remind him that we tried that before and I was not very happy as it required me to reduce my carb intake and live in what for me was absolute misery. I have no desire to be medication-free if it means a poor lifestyle for me. So, he agreed to keep my metformin level as is since (a) my A1c is at the low end of 5%, (b) my fasting insulin level is low, (c) my fasting BG is in the non-diabetic range, (d) I haven’t gained weight since 3 months ago, and other factors (he listed them down as if to convince himself that I really did not need to reduce my metformin dosage).

After we discussed my medication and my next tests (I’m due for annual checks), he inquired about how I was dealing with the weather, eating challenges and other difficulties I may have faced in the last 3 months since we saw each other. And I knew he was listening because he was taking down notes and asking questions. Before I left, he reminded me of some of the things I must watch out for vis a vis metformin (such as stop taking it if I’m having very high fever and the chill, or if I’m vomitting, or if I’m suffering from food poisoning), and to keep hydrating myself as it’s still hot and humid in Tokyo.

When I filed away my copy of my recent tests tonight, I noticed that this month marks my 6th year diagnosis as a T2 diabetic. After consulting my journal, I can confidently tell you that I’ve come a long way. In September 2007, my A1c was 6.8% (that, together with an FBG of 161 and a previous random BG test that yielded 218, sealed my diagnosis as a T2 diabetic). Six years later, my A1c is 5.3% and everything else is within a normal person’s range (in fact my doctor told me that I’m healthier than most of his non-diabetic patients).

I wish I can say that the past 6 years went by in a breeze but I’d be lying. The first 12-18 months was a period of discovery, not just how to live with T2 diabetes but a discovery of myself. The most important thing I discovered was that the secret to living with diabetes is not just to find the right diet (which most newly diagnosed diabetic and even long-time diabetic focus on), but to figure out how one wants to live. I experimented a lot to figure this out. If we don’t know how we want to live, we can’t settle on a lifestyle that we will be satisfied with, which only leads to a miserable existence.

Another lesson I learned is that while we can learn from other diabetics’ experiences, what works for them may not work for us and vice versa. Your Mileage May Vary (YMMV). Your Diabetes May Vary (YDMV).

The third lesson, which I find to be one of the most difficult, is to learn to respect other diabetics’ choice, to not preach, and to not judge others simply because their choice is different from mine.

The fourth lesson I learned is that while it’s not good to preach, it is also important for diabetics, especially T2 diabetics (there are not enough bloggers and DOC participants), to share their experiences and difficulties, to let their voices be heard, and to fight the perception that we deserve our diabetes and that we brought diabetes unto ourselves.

Another important lesson I’ve learned is to not be cynical and to give everyone the benefit of the doubt.

I must say that even after six years, I still have a lot to learn. I’m learning from the DOC, whether it’s through someone’s blog, or through a diabetic board, or twitter, or advocacy sites. I’m glad of the advancement in technology that enable people from different parts of the world to interact and exchange information. I’d be so lost without the Internet.

Today, I look forward to the challenges and humbling lessons that this chronic condition will bring in the coming years. But wherever diabetes takes me, I have no doubt that I’ll conquer it and be on the winning side.

Goodbye Peter

In May, I wrote about people I admired, including Peter, a friend of ours who was battling leukemia. Two weeks ago, he finally succumbed. This is an account of his wake and funeral.

The Wake

We received the news of Peter’s passing on the evening of August 16 (Friday, the night before my recital). My husband had just gotten off his mobile phone after speaking to a friend, when his phone suddenly (ie, by itself) started dialing Peter’s number. My husband quickly ended the call, as he had not intended to call Peter. But he changed his mind and called anyway since he had not spoken to Peter in nearly two weeks. Peter’s widow (whom I shall name Mrs. P) took the call and gave him the sad news. It turned out that Mrs. P had been trying to call my husband but couldn’t get through to him, and my husband’s phone history did not register any call from her. I guess Peter wanted to let my husband know in Peter’s own time.

Thus, right after my recital, my husband and I went straight to Peter’s wake. Like most cultures, Japan has its own traditions in bidding farewell to their dead. In most cases, the Japanese observe Buddhist ceremonies (such as chanting of special prayers by Buddhist priests and the deceased receiving a new name). In Peter’s case, we observed only the secular rituals.

At the funeral home, staff members were on hand to guide everyone on what to do. It’s such a relief not to have to think of what the proper rituals are supposed to be. I should know, as I went through that when my mother passed away nearly 16 years ago and we had to listen to everyone’s idea of a proper ritual for the dead (all based on their own superstitious belief). Here, the staff members take care of that, and they were as unobtrusive as possible. They handed each of those who were present at the wake a white carnation which we placed on a table in front of Peter’s coffin. On another table were placed some of Peter’s favorite things that Mrs. P selected to accompany Peter in the next life. These things included his brushes and paints, a couple of fishing rods, a couple of books, some beret and Japanese bandanas, music CDs and two pair of shoes. After placing the carnation on the table, my husband and I spent a few moments with Peter.

The wake was only for family and very close friends. Peter and Mrs. P had no children, so family consisted of Mrs. P’s brothers and their families, and a niece and a grand-niece (ie, the niece’s daughter) of Peter who flew in from half way across the world. My husband and I felt privileged to have been invited. I learned that evening that Peter was my husband’s very first friend after my husband arrived in Japan some 40 odd years ago.

Peter’s two relatives did not expect to be attending his funeral. They were originally scheduled to visit in October, when Mrs. P, ever hopeful, expected Peter to be in better shape to receive them. But his grand-niece, who was quite close to Peter, couldn’t shake off the feeling that they should not wait and should visit soon. If it weren’t for the fact that flights to Japan were full, they would have left a day earlier and be in Tokyo when Peter took his last breath. But, he died on their way here. Nonetheless, it was providential that they were at least here for Peter’s funeral.

After relatives and friends have had their moments with Peter, we had a simple dinner at the funeral home in his honor. Everyone got to know each other better, as well as spoke about their memories of Peter. The dinner was generally lively, just like Peter and how he would have wanted it to be.

After dinner, we moved to a tatami room that acted as the visiting room. Mrs. P asked my husband and me to join the funeral the next morning. In Japan, it is common to have the funeral the day after the wake (which is usually a one-evening affair). As the funeral and cremation were scheduled for early morning, we stayed the night.

The Funeral

At exactly 8 am the following Sunday morning, the staff led us back to the room where Peter was laid. Mrs. P’s eldest brother delivered an emotional eulogy. Following the eulogy, each person present stood up, walked to the coffin, took a white carnation, silently said his or her goodbyes to Peter, placed the carnation on the table in front of the coffin, and bowed to the rest of the mourners.

After we have paid our respects, the staff moved the coffin to the middle of the room and asked each one to choose something from Peter’s belongings and place it inside the coffin. Mrs. P encouraged us to participate. All the while, she also spoke lovingly to Peter while packing his favorite things with him. After these belongings have been placed inside Peter’s coffin, the staff asked us to place the white carnations inside the coffin. When this was done, we were asked to fill the coffin with flowers from the massive flower arrangement that served as background to Peter’s coffin during the wake. Only Peter’s face remained visible, beautifully and peacefully surrounded by flowers. After Mrs. P’s loving, final farewell to him, the coffin was sealed.

At the ground floor, the ladies were directed outside the funeral home to stand near the hearse, while the men were asked to carry the casket to the hearse. Mrs. P was escorted to sit in the hearse while the rest of us got unto an air-conditioned mini-bus that brought us to the crematorium, which was just a few minutes away from the funeral home.

The Cremation

At the crematorium, each of us was asked to again place a white carnation on a table in front of the coffin. The carnations, together with a bouquet of flowers, were laid on top of the casket.  Also on the table was the urn where his cremated remains will be placed.

We then accompanied the coffin to the furnace. I expected to see fire when the furnace door opened, but there was none. After the furnace door closed, we were escorted to a waiting room on the second floor. Various beverages including beer were served. We spent the time getting to know each other even more. I learned that Peter’s niece is a Type 1 diabetic and that although she generally does not eat a lot of carbs, she partook of the sushi and tempura served at dinner at the wake. I would not have guessed she was diabetic if her daughter did not casually mention her mother’s high FBG. To all nervous Type 1 diabetic would-be moms, I can tell you not to worry so much. Peter’s niece has two beautiful, smart and outgoing teen-agers.

After nearly an hour and a half, the crematorium’s staff asked us to return downstairs. But first they asked Mrs. P to identify Peter’s remains. I guess they meant Peter’s glasses or remains of his fishing rods, and to confirm that he came out of the furnace he went into earlier. They wouldn’t allow Mrs. P’s brother to do it for her, but gently insisted that Mrs. P herself (accompanied by her brother) make the final confirmation.

In the meantime, we were escorted to a small waiting area. I could smell burning. The smell wasn’t offensive at all, just the smell of burning. When Mrs. P and her brother, accompanied by a staff member, appeared, they came with a rolling table with a tray of bones and an empty tray. Yes, bones, not ashes. I was expecting ashes, but my husband told me the Japanese usually do not ask the bones to be ground to dust.

After a few introductory words, a staff member set aside the bones of Peter’s skull on the empty tray, then asked us to line up in twos. We were asked to pick up a bone, two at a time, with chopsticks and transfer it to the urn. I believe that two people were supposed to either pick up the same bone at the same time or pass one bone from one person to the other, in either case using chopsticks. But we did not do either. Rather each one simply picked up a bone and gently placed it inside the urn. I figured that since none of the mourners was Japanese, the staff did not see it necessary to correct what we were doing. It taught me that not all Japanese are punctilious about procedures. By the way, the ritual explains why, in Japan, no two people hold anything (especially food) at the same time with chopsticks or pass anything from chopsticks to chopsticks – this is considered a major social faux pas.

After we all had our turn, a senior staff member carefully placed the remaining bones inside the urn. He identified some of the bones, such as the knee and a neck bone (which I understand is the most important bone). The last bones to go in were Peter’s skull bones. Once the transfer was completed, the staff took out a brush and a small pan, and collected every single speck visibly left on the trays and deposited them into the urn. Then, he covered the urn and handed it to Mrs. P.

Lunch

After the cremation, we went back to the funeral home for lunch. At the head of the dining table were Peter’s self-portrait on an easel and a small table with an offering of food and drinks. Like most Buddhist societies, we offer food and drinks to the deceased so he or she wouldn’t go hungry or thirsty in the afterlife. We ate and drank to Peter’s memory.

Finally, we went home.

Peter’s memory and his last days

Peter was a well-loved man. He was a kind man with an infectious sense of humor. His niece told stories of how, when he visited home, he would regale them with tales of his travels and exotic Japan. He also adjusted quickly to technology and loved to talk to people, including his grand-niece, on skype.

The past seven years of fighting leukemia could not have been easy for Peter and Mrs. P, especially in the last couple of years when his kidneys failed. But both of them managed to find humor in his situation, and was even able to travel to Thailand more than once when his dialysis requirements improved. Mrs. P told us that during one trip, when the airline staff saw Peter’s condition, they were bumped up to first class. They certainly enjoyed it.

Peter’s condition deteriorated in the past few months, although he tried to be upbeat. But his doctor said that the only treatment left for him was either not approved in Japan or was waiting approval (sorry, I can’t remember which). In any case, he could only get the treatment outside Japan, such as the UK. He thought that it was time for him to go and for Mrs. P to move on with her life. He ultimately asked Mrs. P to “finally let him go” (Mrs. P made him promise he can’t go unless it’s with her permission). It was a difficult decision to make, but she did let him go.

One of the last things they did was to visit a fishing tackle shop. Peter used to fish and collected fishing rods and reels. Mrs. P arranged for medical transport and help so he can visit the shop. He spent about half an hour in the shop and was ecstatic to see all the fishing gears and equipment. I’m sure he couldn’t have asked for better last few days in this plane of existence.

Two weeks ago, on my late mother’s birthday, he went peacefully.