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Scott Benner 0:00
Whether it's shots, pens or an infusion, needles are part of life with diabetes, but what if just the thought of them makes your heart race today, Erica Forsyth and I are going to talk about the fear that's more common than you think, needle phobia. You

if you'd like to reach out to Erica, she's available at Erica. Forsyth.com 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. Don't forget, if you're a US resident who has type one or is the caregiver of someone with type one, visit T 1d exchange.org/juicebox right now and complete that survey. It will take you 10 minutes to complete the survey, and that effort alone will help to move type one diabetes research forward. It will cost you nothing to help when you place your first order for ag one, with my link, you'll get five free travel packs and a free year supply of vitamin D drink. Ag one.com/juice, box, the diabetes variable series from the Juicebox Podcast goes over all the little things that affect your diabetes that you might not think about travel and exercise dehydration and even trampolines. Juicebox podcast.com go up in the menu and click on diabetes variables.

This episode of The Juicebox Podcast is sponsored by cozy Earth. Use the offer code juice box at checkout at cozy earth.com and you will save 40% off of your entire order. Today's podcast is sponsored by us med. Usmed.com/juice box. You can get your diabetes supplies from the same place that we do, and I'm talking about Dexcom, libre, Omnipod, tandem and so much more us, med.com/juice box, or call 888-721-1514, Erica, welcome back. It's good to see you.

Erika Forsyth, MFT, LMFT 2:17
Thank you. It's good to see you too. We

Scott Benner 2:21
just finished up our our short series on caregiver burnout, and we're jumping right into another, another sizzling topic, needle anxiety and needle phobia. You were nice enough to pull together some some notes and thoughts. I've been doing the same. I've also put up a post in the private Facebook group. It's been up now for about a month. It got back about 50 comments, people sharing their needle phobias and stories and some things that helped them. So we're going to weave that into this conversation. But overall, I think that people with diabetes can get, I can't believe I'm going to say marginalized, but I think they can get marginalized around this because people just say, Oh, you have diabetes. You must be fine with needles. That's it, as if having a needle phobia goes away if you have type one or type two, which is just kind of silly, but definitely what I've seen in the world with Arden over and over again, dentists, blood draws anywhere where you intersect a needle. People just assume, like, Oh, you must be like, totally cool with this, because you have diabetes. But I don't think that's the case, absolutely.

Erika Forsyth, MFT, LMFT 3:25
And I think one of the interesting research facts that I learned is that it's really common to have a needle a fear of needles, needle anxiety, or actual needle phobia, which the technical term I also learned is trypanophobia, okay, which is the intense fear or aversion to needles injections or medical procedures involving needles. And if you have kind of the diagnosed trypanophobia That is a specific phobia, meaning it's you have this irrational and overwhelming fear that goes beyond the normal discomfort most people feel about needles, but from this research, this is 25% of adults, 50% of teens and 63% of kids are freaked out by needles, And that's from the make Foundation website, which I'll reference throughout our conversation, which is a great practical tool, but I just think, Wow, that's a lot of us out there in the world, whether you're living with with diabetes or not, that most of us, when we go and get our blood drawn, aren't like, feeling great about

Scott Benner 4:37
it. People aren't just like, oh, this is gonna be awesome, right, right? And why would you I don't have a phobia. Like I have a procedure, I realize, like, if I get a blood draw, I've learned to breathe in during the needle being inserted. That was my thing. Like, you inhale as that's happening, and something, it lightens the pain. But in the end, you're at the you're at the mercy how good you're full of. Omnis is a lot of times too. You know, that's

Erika Forsyth, MFT, LMFT 5:02
so interesting. I do the opposite, Scott i I've learned to breathe in, and then as soon as I feel the needle going in, I breathe it out. Oh, okay, right in that moment. Anyway, whatever works Right, exactly, right.

Scott Benner 5:16
And it just, it's tough, because I was getting blood draws a lot for a stretch, back around my low iron problem, which I thankfully don't have to do anymore, but I was found myself there a lot, and you really do learn it is a crapshoot. The person who's helping you is either sometimes magical at it, yes, or it just feels like they're just like, just hoping the blood comes out, you know. So I can see that being a problem. But anyway, this is a much larger issue than you would think, and I learned that reaching out through the Facebook group, but also to be candid, and I'm not going to share over share, but Arden has a pretty significant phobia, and I'm confident calling it a phobia, based on her reactions to to injections. So anyway, where do you want to start? Yes,

Erika Forsyth, MFT, LMFT 6:01
so I think just having an understanding that it is really common, and there's nothing wrong if you have a needle, a fear of needles. And I also think it's important to note that while we're going to be speaking about this for the person getting injected, whether we're talking about IVs for a procedure or blood draws or site changes or injections or insulin. I also want to just note that parents who are having to inject or chase their child around or hold them down, you can also have a real traumatic experience as you're trying to save your child, right, keep them alive, but in so doing, you are feeling like you're instilling this traumatic experience on them. And so we want to walk through some of these experiences and tools, but just that that is so painful and so hard emotionally for you as the parents. So I just want to address that, and what we will speak to that as we work through these topics? Yeah,

Scott Benner 7:01
that's awesome. I concur. I've have had the experience. So I know it's I know what it's like. Can I read this thing that you have here from the MEG foundation? Yes, pain is a biological, psychological and social experience. On the biological side, the body's way of telling us something is wrong to check it out. A nervous system sends messages to your brain. Our physical state impacts how painful something can be, like hunger, sick or tired. So, yes, okay, and then psychological here it says, pain may be worse depending on our mood. I didn't know that. And socially, how we react or view others around us impacts how we experience the pain. Wait, what does that mean?

Erika Forsyth, MFT, LMFT 7:42
Yes, so, okay, so, for example, I think as we talk about pain from this framework that it's a biological, psychological and social experience with the social part when your child is running down the street and they trip and fall and they skin their knee, and they look at you as the parent, and if you are, we've talked about this even in the parenting series, overreacting and oh my goodness, do we need to go run home and like, over, over, over, dramatize the situation that child is then learning, oh my gosh. This is really scary. I really hurt myself. This pain is really bad. And I certainly we're not encouraging you to like, to be like, you're fine. Get up, you're fine. You know, it's finding that sweet spot of enough validation without over dramatizing the moment. Okay,

Scott Benner 8:30
that makes sense, and I've tried that while Arden is upset about an actual injection, and truth be told, like they doesn't get us to the finish line, but it does, I don't know. I mean, the reason I brought this up to do is because, after having this experience with Arden for so long, and then I was like, let me reach out and see how other people are feeling about this, and then getting so much feedback back from people, I thought like, I mean, I know you have to do it to stay alive, but the minute that it doesn't become to stay alive, Arden will do anything to avoid it. She becomes the bad guy in a bad movie when he's caught. Like, you know what I mean? She would do or say anything to avoid the injection, like it and she doesn't. She knows it's not making sense while she's doing it, it doesn't matter. Like, it's irrational, oh, she's begging for her life in that moment. Is how it feels really. It's really sad, but interesting too. Yes,

Erika Forsyth, MFT, LMFT 9:22
it's so intense. And when we're gonna talk through that, that fear that feels so consuming, but yet you can, you can have an out of body moment and say, Gosh, I know this is I know I'm gonna be okay. I know it's gonna hurt for a second, and then I'm it's gonna be over. But in that space of anticipation and fear can become so overwhelming and paralyzing. Yeah,

Scott Benner 9:47
and it doesn't seem to make any sense, because the second it's over, like laughter will come sometimes just like, from abject fear to like, just, I can't believe I was that upset. She will tell me that part. Of the consternation in the process is that she understands how ridiculous it is that she's scared and she's almost scared and mad at or embarrassed with herself at the same time. Yeah, yes,

Erika Forsyth, MFT, LMFT 10:15
there's, there can be so much shame attached to this experience, and I think it's important to understand as we talk about the pain, it's not just about the needle or the pinch or the site change pain, right? So, and I think also the physical state impacts how painful something can be in the biological realm. So if you are hungry, tired, sick, you're going to experience your brain is going to send in the nervous system that message like this hurts way more now because I'm sick and tired or hungry, that if you are not those things, just something to remember. Do you want to

Scott Benner 10:54
go through the causes of needle phobia? Yes, yes. So

Erika Forsyth, MFT, LMFT 10:57
and what we ultimately want to get to is when you are stressed, it's going to feel more painful. When you don't have any support or validation, it's going to feel more painful. And again, I'm talking about psychologically and physically. And so we want to get to a place of having more coping skills, and you will feel more in control of the situation, so that the causes could be a variety of things post traumatic experiences. For example, you might have a painful or negative medical experience from a procedure and and someone referenced this actually in the Facebook group where they had a procedure and they couldn't find their vein with the IV and they were poked 32 times. Yeah,

Scott Benner 11:42
that'll stick with you. Yeah, that's a real

Erika Forsyth, MFT, LMFT 11:44
trauma. Yeah, you are then probably going to have to work through that experience every time you go in for, you know, any needle blood draw or IV learned behavior, observing someone else's fear of needles, or hearing stories about expat bad experiences. So even now as you're listening to this, just be mindful if this is becoming overwhelming for you, as we talk about needles or hear us reference various stories and you already are in that space, maybe pause. Take some deep breaths. Come back to this episode. You might just have a biological predisposition. You might just have a genetic tendency to develop intense fears, and it's being played out with the needles. Interesting, the basal vagal response, and some people also reference this experience in the Facebook group, that even the site or anticipation of the needle causes a drop in blood pressure and heart rate, which is then going to lead you to faint and possibly vomit. And then when you have those experiences connecting to needles, that's going to reinforce, oh my gosh, this is a really scary thing. I don't want to I'm going to avoid at all possible in engagement with the needle. Yeah, so those are some possible causes of needle fear or needle phobia.

Scott Benner 13:02
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Erika Forsyth, MFT, LMFT 17:33
It's makes so much sense, right? It's so connected to all the different systems

Scott Benner 17:37
go through the symptoms of what happens when it when it strikes you, okay,

Erika Forsyth, MFT, LMFT 17:41
and so these and these symptoms can be, as you said, you know, for days in advance, she's thinking about that injection. So this could be occurring for you or your child, seconds, minutes. You know, we site change every three days, 10 days, right? That you anticipate the physical symptoms could be increased, heart rate, sweating, nausea, dizziness or fainting. Someone in the Facebook group said it feels like a low, like you're having a low blood sugar episode. The emotional symptoms could be intense, fear, panic, feeling of dread at the site, or even the thought of the needles, and then behavioral, you know, avoid avoidance of the medical procedures, maybe skipping vaccinations, refusing blood tests, despite knowing that perhaps it's going to help you in the long run, or for your health. And it's important, you will avoid being, you know, interaction with the needle. And then what happens as a result? Right? If you do have needle phobia, you might delay the treatment or the or the blood test, or even, you know, a surgery, possibly some people shared very vulnerably about that experience of wanting to avoid the needles that were so it was so scary that you you risked other components of your of your health?

Scott Benner 19:02
Yeah, they're gonna let other aspects of their health fall apart to avoid this needle thing, yes, yeah, it's very real. Yeah. I didn't realize how big of a deal it was people when Dexcom, I don't know what people are gonna remember, they used to have that inserter that was kind of like the clear tube, almost, it sat on an angle, and you had to plunge it yourself, and you could kind of see it all happening. And when, when they went to a self inserter, like, is on this the g7 a lot of people like, well, that's way better, because you can't see the needle. It's such a big deal for me, they would say not to be able to see the needle first. Yes, I guess it's just another one of those things. If you don't go through it. It's not going to make a ton of sense to you know what I mean, like, just, unless it's the way it hits you, you just pick out just it hurts for a second, or it pinches. Or sometimes you hear people say, sometimes doesn't hurt at all, depends on where it goes in. Or sometimes it's things. I take an injection once a week, and I mean, I'm like, like, I the other day I realized I didn't do it. I. I was sitting on my desk, I was getting ready to go out, and I went, Oh, I should have done that. And I just yanked my shirt up and went, click, boom. And I and I just left. I didn't think twice about it. And then later I looked back on it, I thought, Oh, gosh. Like, you know, Arden's like, oh, let's do it. And then the needle comes out, and then it's like, this, slowly I turn thing, and then she's just going in a different direction. Anyway, I just, I want to say, like, if people are having these kinds of reactions, I know, like some of you are like, you know, some some people are using needles to dose insulin, like a lot of them are. But if you're having this reaction, it's, it's tough call, because you got to do it. You can't not do it right and but at the same time, I don't think, I don't think that ignoring it or just acting like, Oh, come on, it's not that big of a deal. I don't know it's tough because I also, I also take your point about like, not making a big deal out of it. Like, like, you know what I mean? Like, you don't want to start like, because somebody's like, I don't want to do that. Of course, they don't want to be like, no one wants to do that. But if you just go, Okay, well, you don't have to, like, are you setting a precedence where it's not that, you know, oh, we'll skip this correction. Your blood sugar is only 180 we'll just let it sit like this for a few more hours because you don't want to do this. I'm sorry. It's just, it's just another thing. We talk you and I talk about that. I'm just like, seeing both sides of it, and neither side feels exciting. But I'm sorry. Go ahead. Go Yes,

Erika Forsyth, MFT, LMFT 21:17
No, you're good. I think just the validation of like this is really complicated, and definitely in seasons of your life, living with with diabetes or with your child, it might feel like it's never going to get better. You're never going to get over it, right? And if you have a needle phobia, it's not necessarily. We're not saying hey, we're going to give you the steps to get over it. We are here hoping to to validate your experience, but then also to provide some tools to help you manage your emotions, your physical pain, through it. Shall we move into some some tools and coping? Yeah, yeah, please. That'd be awesome. Okay, okay, I know I've heard and seen a lot of people use the buzzy bee product, and on their website, they actually had a really great thing that I loved, of making kind of addressing pain and the needle moment in a three prong way. One is to make a plan to address the anticipation or fear, and we're going to talk about that. And then two, manage, have a plan to manage the actual pain during the injection. And then three, have something to focus on during the injection. So I'm saying injection for all the all needle examples that we've mentioned. Yeah, one of the things, the reason why we want to focus on that it's a psychological experience, because what we are telling ourselves beforehand is so important, and obviously one of one of the treatments that if you are in a really needle phobia would be cognitive behavioral therapy, in addition to all the things we're also going to mention, but that would be really important to address. Do you have post traumatic experiences from needles. And then how can we work through that trauma, by also understanding how your thoughts and feelings are affecting your behaviors? That would be kind of on the more, perhaps not necessarily extreme, but more intense or severe, needle phobia, as well as exposure therapy. I was just thinking about, you know, the picture that you posted with when you asked for,

Scott Benner 23:21
oh yeah, that's threw people off, even then someone

Erika Forsyth, MFT, LMFT 23:25
said, Oh my gosh. That makes me scared. And, I mean, it was an intense picture, but it did grab people's attention. And, you know, exposure therapy would be beneficial, like, if you had a visceral response experience or response to seeing that picture, that could be a cue to say, you know, maybe, maybe exposure therapy could be helpful for you to, not to. Basically, you learn the coping skills as you are exposed to that trigger. Yeah, so perhaps you're talking about needles, and then you're working through the coping skills, and then you're envisioning it, and then you see a picture of the needle. Then maybe you're holding the needle and then you're giving yourself the shot. Those are kind of the therapeutic approaches. So the rest of the things we're going to talk through are things that a lot of you already probably do, but we wanted to kind of leave them all here in one, one space, a lot of these things you guys referenced in the Facebook group, and things that I do myself, and then Scott does so just not looking when it's happening. I know that seems really simple, but what you want to do is give your child or yourself that option, all of these things. We want to give yourself and your child the control, and one of the things from the MEG foundation for pain.org, website, they have great you can have an app, have kind of a whole little plan, a printout. So as we go through all these things, you get to engage with your child or yourself. What is helpful for me? What? So we're making a plan. Mm, hmm. To reduce the fear. So do you want to look or not look when it's happening? And you have this discussion, but way before, and a lot of you probably already do this, right? Do you want to hold this stuffy or that stuffy? Do you want to do it in 10 minutes or 20 minutes? Do you the shop. These are more kind of the actual tangible things, the shot blockers, which I've seen some pictures of. I've never used them myself, but apparently they are really effective. And they have, like, the little raised, yeah,

Scott Benner 25:33
they kind of seen them. They kind of conf you. It's like a plastic thing you pinch with a little bit, I guess it's got little, like, pokey plastic things that kind of confuse your your nerve endings, right?

Erika Forsyth, MFT, LMFT 25:42
Yes, yeah, yeah, blunt skin contact points is what they call them, okay? And so you push it down. I don't know, I so I apparently though they're really effective. The buzzy bee is the vibration. It has vibration with a cold pack. I know a lot of people use that the numbing cream, specifically Alma cream is been referenced a lot. I port from Medtronic, yes, as helpful for people for injections. Dia Spider was a new product that I discovered upon researching for this chat. Apparently, I think it's for insulin pens, and it kind of looks like it combines elements of the shot blocker, yeah, basically I'm like, the shot blocker, and just a total distraction, have you? Are you looking at?

Scott Benner 26:33
Looking at a picture of it now, yeah, oh, I see. So it goes around an insulin pen to kind of like, give you the the shot blocker, feeling like something touching and giving you that that confusion, plus it makes it look a little more, little less like an insulin pen might be good for kids like visually as well, yes,

Erika Forsyth, MFT, LMFT 26:51
and also has you know, you choose your color again, this is really To instill control and coping and choice reduces that anticipation and fear, and then hopefully also simultaneously reduces that pain in the moment. Well, apparently, being hydrated or not is really important for pain of the actual injection. Plus, if

Scott Benner 27:17
you're doing a blood draw, so that your yes, the blood volumes up and your veins are easier to get to. That that can also be really helpful. Yes, I read about that too. Even just the having someone drink 16 ounces of water before the injection, it almost like takes their mind off of it, because you're, like, trying to get down 16 ounces of water. Like, yeah, right, it just sort of, it takes your attention away a little bit. That's what I never thought of. What else you got on this list? That's so

Erika Forsyth, MFT, LMFT 27:42
that's so good, because what you have, you have a goal, and you're focused on that drinking, and it has a kind of a two prong positive outcome, play, have a calm music playlist. These are a lot of things that people mentioned in the Facebook group, laying down, or laying down with your knees up, having peppermints in your mouth ice pack on the back of your neck. You know, we talked, we already talked about, you know, inhaling or exhaling, breathing is really important. Oftentimes, we hold our breath when we're scared. One story that the founder of Meg foundation, I wrote her name down here. I'm just looking

Scott Benner 28:18
here. By the way, cool flavor a room of peppermint can redirect attention from the needle to the sensation in the mouth. Gives the brain something else to focus on, helping reduce the intensity of anxious thoughts. No kidding, I love Yes. Could also be grounding. Sucking on the mint can be grounding. Peppermint has calming effects to some people. Anxiety causes dry mouth. The peppermint can stimulate saliva production, making the person feel more physically comfortable. How about that? And because when you said that, when I was like, what peppermint? I'm sorry, I got you off.

Erika Forsyth, MFT, LMFT 28:52
No, that's good. No, peppermint is well, also peppermint is good with, like, nausea too. You might have already just said that.

Scott Benner 28:58
Oh, listen, I went to school in the 80s. If you went to the nurse and you didn't feel well, they gave you a peppermint water to drink and then sent your ass right back to class you don't feel good, drink this now. Get out of here. That was childcare in the 80s. Yes,

Erika Forsyth, MFT, LMFT 29:13
peppermint cure it all. So, so Dr Jody Thomas is the one who created the make Foundation, and she shared this story as she was in training about breathing. And I just thought it was so great. I wanted to share it here, also with and some of these coping skills will work for you or your child for a couple months, and then, just like anything else, you might need to switch, but the breathing, she asked the child, and you can do this for yourself as you're about to get the blood draw, envisioning a color that feels calming or comforting, and then think of a color that is like painful and uncomfortable. And so the child said green, so they and black, green for comfort and black for pain. And then so she, you know, had her close her eyes and invited her to think about inhaling the green and images of green and then exhaling black, the color and feelings around it. And so I just thought that I liked that we've talked about different breathing techniques, but I liked that one to share here. It is

Scott Benner 30:17
important too, because I think when people tense up, they do stop breathing right away, which, you know, a bunch of physiological reasons not to do that. But this is, it's a nice idea. Like, take the good stuff in, let the bad stuff out. Be visual about that. Like, in the end, I'm going to tell you something. I've tried a lot of this stuff with Arden, and usually what she says is, and we'll probably have to bleep this out, Q, that's not going to help, right? But in fairness, I didn't have a lot of luck getting her to do the things. And so I did say, I'm like, I do think we should do some breathing stuff. I do think you should look away for she's like, I have to see it. I'm like, Why are you torturing yourself like she stares at it while it's happening. One time she said, I just want you to just do it, but I'm gonna defend it if it happens. So somebody's gonna have to hold my hands. My son came into the room and literally, like, held her wrists out in front of her while I did the injection. It was horrible, honestly, for all three off, all of us, all three of us, had a different, horrible experience. But as I and it's a self injector, Erica, it's like, click and over. Like, it's that fast, right? And while it's happening, I hear, like, in kind of an amused tone for my son, She's biting me. Then it ended, she cracks up laughing, and she's like, I'm so sorry. I didn't mean I thought I was biting my own hand. I couldn't even tell it wasn't me. Like, she was just looking for some like, I don't know, release, release, yeah, yeah, something. And I'm telling you that all of this took, I mean, it took like, 10 seconds, and it felt like, it felt like we were fighting a war. When it was over, everybody was just like, we did it. But five minutes later it was, it was just like it had never happened, like she and I went out to do the next thing we were going to do, and was just over. It was I looked at her for an hour after that, being fascinated at where we were an hour previously, you know, just really something anxiety and and that adrenaline and the fear mixed together. It's just, it's bad stuff, you know,

Erika Forsyth, MFT, LMFT 32:18
yes, well, but I love that she like part of, you know, if you wanted to use the plan maker resource, it's beforehand going through like because, you know, she likes to look at it. And now you know, like physical touch. You know your body, your brain, can only focus on so many points of physical touch. And so you know, as little as often times with parents, you might hold your child on their lap as they get their, you know, immunizations or their injections, holding asking like, do you want? Do you want me to hold your wrist? Do you want me to give you a tight hug? You know, research shows that, you know, laying your child down on their back and holding their arms down is actually pretty negative, yeah, in terms of their medical trauma? Yeah, they will probably have some medical trauma around that, because it's you're so vulnerable and pinned down. But I also know we have sometimes you have to hold your child to make it happen. So just if you can holding them on your lap, Wrapping Arms Around like you're giving them a big hug, but they're sitting up. I wish

Scott Benner 33:17
that this would have been talked about when Arden was younger, because she was like a chaser around the house kid, you know. And I do wonder how much of what's happening to her now is from back then, because all I knew to do was, like, grab her and do it. You know what I mean? Like, it's, I mean, Erica, it's, you know, you were injecting insulin. It was happening a number of times a day. And yes, you know, sometimes she was cool with it, sometimes she wasn't. But I do wonder how much of the process that we went through led to where we are now, and I'll never know. I I'll tell you that before she went off to college, Arden hasn't had a correction with a pen ever. Arden's never used an insulin pen once. So she went right from syringes to pump to Omnipod. Yeah, me too, yeah. And you've never used the endocrine and so she stopped injecting when she was four. That's when she got an insulin pump. And I've told this story before, but that a couple of years later, I wasn't sure if she had a bad site or something, but I wanted to inject insulin to check. And we got the syringe out, and she didn't remember it, which, at the time, I took really well. Like it was a couple of years she was maybe six, seven years old. At this point, she hadn't had a syringe in a few years. She's like, what is that? And I was like, Oh, we're gonna have to inject the insulin. And I just acted like, you know, this, I've done this to you 10,000 times, you know? And she had no memory of it, which I thought was great. And it was for a long while, but then all of a sudden, I don't remember exactly how old, but maybe a couple of years later, we were just at a blood draw one time, and she, like, climbed the wall, almost in the room, to get away from it. And then suddenly she had her it felt like she overcame it, but she tells me, in retrospect, she didn't overcome it. She was just like willing herself through it. She was having the same feeling every time it. Wasn't until we got to this send her off to college, situation where I said, Look, I can't send you off to college, not knowing if you can give yourself an injection. If something goes wrong, I'm like so your next bowl is today. Let's just draw it up in a syringe, and you do it. She took that syringe and stared at it for 20 minutes, and then eventually left the room. She locked herself in the bathroom with it, and she came out 45 minutes or an hour later, and she's like, I did it. But she looked like she just ran a marathon coming out of that room, like, I don't know what she went through. She wouldn't let us in, she wouldn't let us help. She's like, I'm gonna do it. I'm gonna do it. It was an hour and I swear to God, she came out. She looked like she just been through three rounds with a heavy weight. She was sweaty and disheveled and like she looked half crazy. She's like, alright, I did it, and that was the end of it. And I don't think she's done another one since then. It's been, like, three years. But anyway, and then people say, but there's a needle in the Omnipod, the one great, one of the great things about that Omnipod is, you put it on, you pinch, you push the button and it's, it's between you and Jesus at that point, like, it's just gonna happen. You know what I mean? So you like, you click, and you just kind of wait. And she doesn't have any problem with the with the Dexcom inserter for the g7 either she doesn't like it and she flinches every time, as if it's never happened to her before, which I've always found interesting. Like, like, it never stops being what it is. If that makes sense, yes, we're not through all your tools, though. I apologize, yeah, but you

Erika Forsyth, MFT, LMFT 36:26
know, but she does so well. That's, I think that's really common, though, for those of us who are on devices, CGM pumps, but to also, as you said in the beginning, to have an aversion to needles or blood draws or IVs insertions, because it's out of our control. Yeah. And so there's something, you know, and I think however you can set up, like, for example, going into a blood draw when she, you know, said she's just crawling up the walls. I think the more you are able to understand what you need, even if you feel like it might not even help, but to then advocate for yourself in that way. Some of these, I thought these were really great examples of if you're able to get an appointment, a lot of people are not able to get appointments for blood draws, but to prevent the time in the waiting room while you're watching everyone else feel nervous, maybe you're hearing kids scream like so if you can get get a blood appointment or ask to be outside and get a text when you're there, your numbers up, yeah, for some people, some people, you can schedule it with the same, you know, Nurse phlebotomist, and develop that relationship. I actually just learned recently I've I my veins are hard to to access for whatever reason. They just, they like to hide. And so I know on my left arm, I know the vein that works. So for years, I go in, I don't look, I point to the vein that works. And they say, Are you sure? I'm like, yep, just this vein. Just do that one, yeah. And I look away, and I do my inhale, I exhale when I breathe, but just this last blood draw, the nurse said, you know, I I'm noticing some scar tissue here. And I said, Oh, why? No one's ever told me that. I just know that's the vein that's easy to find. So anyway, something I said, is that problematic? She said, No, we just might need to use a smaller needle, whatever.

Scott Benner 38:16
I guess, like, I need the spot to last at least, like, 4050, more years.

Erika Forsyth, MFT, LMFT 38:21
So, you know. And also to say, when you get walk in to sit down, if you know your plan, you can tell the person, hey, I'm not going to talk to you. I'm going to look away. This is the arm that I like. I need to lay down. So you're not in your head worrying, yeah, you're not worrying about, oh, do they think I'm rude? Or do they? You know, it doesn't matter,

Scott Benner 38:42
right? Just give yourself less to worry about, yeah, by being prepared ahead of time.

Erika Forsyth, MFT, LMFT 38:46
Yes, yeah, um, one, 1% person said this in the Facebook group, which I think is great if you're an adult and you have children, but you're the one who's having to get the needle blood draw, have your child come with you, because oftentimes that their presence might either calm you, or you might have to stay more calm because you don't want them to see your fear. That I know that can be helpful. Sometimes this

Scott Benner 39:11
person in the group said that I used to pass out when I was going to get a flu shot, and I'd feel kind of woozy. My dad would pass out as a kid from getting it, and and so prior to having to get my first COVID shot, my mom took me to a therapist to do EMDR therapy, and I think that helped that interesting, like, that's the pre planning we're talking about. Also, the lady that did my COVID Shot said to me, this is my first one. I'm a volunteer, and then stabbed me like we were in the middle of World War Two, and she's trying to kill me on the battlefield. And I was like, Oh, wow. It's supposed to go on your arm, but down a little bit, I think she stuck it into my shoulder, my shoulder. I was like, what is happening? She got done. I went over to my wife, and I was like, oh, oh god. What happened? She goes, what happened? I said she hit me in my shoulder. Should have known, because five minutes before, she shouldn't figure out how to use the iPad. And I'm like, You're right. And she goes, this is my first one. We're all volunteers. And I was like, oh, okay, I thought that meant she'd be more careful, not that she'd just swing like Jason in the Friday the 13th movies at me. It was not pleasant, but again, I lived through it, yes, yeah. And I also don't have a needle phobia. So in the end, I just had an unpleasant experience. I was like, yeah, that hurt. Like, what'd you do that for? And then, like, I was done with it. But if, but if I was predisposed to this, that one experience could have put me down a bad path, for sure, because it was a, it was a really crappy experience, to be perfectly honest with you,

Erika Forsyth, MFT, LMFT 40:37
absolutely may perhaps had you been in a real, you know, anxious space or fearful space, you maybe have the plan to say, I'm going to ask for what I need, and I need someone who's with experience. Yeah, I think we get, we get nervous when we when we are nervous, we often feel fearful to say, You know what I'm going to pass I'm going to wait for this person over here who says they have five years experience, whatever. I wouldn't wait

Scott Benner 41:02
for the lady who knows, though, how to open the iPad that might have been like, like, at least she's been here a day. I would think, usually what I tell people in these situations, they're like, Oh, this is gonna hurt, or I'm sorry. I go, I'm married. It's okay. I'm trying to make light. But you know, humor, I've been through a few things. This isn't gonna be the worst thing that's happened to me today. You should be around with my wife yelling at me about something, this is nothing, or else, something like that, which not even true, but fun to say. I don't but I do wonder, in a real, in a real way, like, it's just like the other stuff that we talk about, where you have something, you don't have something. It's like, when you're talking about somebody with anxiety, I'm like, It's so strange for me to listen to somebody speak with anxiety, because I'm like, I just don't feel that way, and I feel lucky not to feel that way. But this is the same idea. Like, I know the needle is gonna suck, but like, I just don't care. Like, it's gonna hurt, and then it's over. I don't even have trouble the dentist. And I hear some people talk about going to the dentist, like, like, it's the worst thing that's ever happened to them, you know, anyway, I'm sorry. What? Keep going. No,

Erika Forsyth, MFT, LMFT 41:57
well, and speaking of the dentist, I think the I was going to share an example recently with my my daughter, who had two she had two cavities, and the first time we went, we didn't give the we didn't give her the laughing gas. And it was, she was highly anxious. She said it was really painful. So we didn't do the second one. We went back a couple weeks later, did the laughing gas. It still was, it still was painful for her, but her anxiety and her pain scale was a lot lower. Same procedure, same steps, except she had the laughing gas. And I think just our emotional state is so important to acknowledge in conjunction with the actual perceived level of pain. Yeah, right. And I joked with our pain, yeah. I

Scott Benner 42:43
was like, You want us to try to find you some weed or something before we have to do this again? It's like, well, I'm starting to think, like, what's going to help her relax before she has to do this? And I don't know if that would help or hurt her, not, but my brain went there. I thought, Is there something we should do to, like, get her a little loopy first? You know what I mean, like, so I don't know, we didn't end up trying that. But anyway,

Erika Forsyth, MFT, LMFT 43:06
medication, yeah, you know pain medication, or anti anxiety, you know Xanax in the moment. Some people need that, and that's totally okay. I mean, that's your situation. Get something done, right? Like you need to do the thing to keep yourself healthy and to help find a way that works best for you. Is, is great, whatever that, whatever that may be, I'm imagining

Scott Benner 43:29
people showing up the dentist a little, a little half in the bag, going like I was listening to a podcast. They said, sorry if I chilled out a little before this. But I do wonder, how many people do that, self medicate stuff like that. I bet you more than you think,

Erika Forsyth, MFT, LMFT 43:43
yes, and it's okay to ask, right? Like, ask your doctor. Hey, I have, I have needle anxiety, and I have this blood draw. Can you prescribe me one Xanax? I think that's totally probably more common. It's something that people don't talk about. Yeah, this at last one is the the kind of correct term is applied Tension Technique. But basically, if you are if you feel like you're going to faint, just squeeze your muscles, your leg muscles, your butt muscles, your abdominal muscles, repeatedly while the needle is going in, it's keeping your blood circulating through your body okay, and will prevent you from, hopefully from from fainting. So knowing like and you can pre you practice that with yourself or your child. Okay, I'm going to squeeze my butt or my legs or my stomach, and we're okay. We're doing 123, we're going to press the button, any tool or tip to do beforehand, to talk through, to practice, gives both yourself or your child that confidence, that you know what to do when the fear starts and when the pain starts, the physical pain.

Scott Benner 44:51
What is this here? If you're for adults, if you have kids, have them present to watch, and that may be Oh, because parents feel like they got to hold it together. In front of their children? Yes,

Erika Forsyth, MFT, LMFT 45:01
yeah. So I was, I think someone wrote that in the Facebook group and, yeah. So like, if you're this is for someone as the adult, if to try, if that helps, right? Because you want to be calm for your child. You're trying to model for your child, and having your child present as you're having the needle inserted, you're thinking about them. You're not thinking about what's happening. You're staying calm. That could be another tool. I mean, I don't know if you want to intentionally do that, but if it happens, that has worked for some people.

Scott Benner 45:31
I mean, that makes sense to me. I mean, all these things you got to pick and figure out what's going to help you, for sure, yes, but that makes sense to me,

Erika Forsyth, MFT, LMFT 45:38
you know, and having the actual distraction when it's happening. We've talked about the medication, the mindfulness breathing, I think we've covered most of the tools. And just honestly, if you if you're hearing this in your experience needle phobia, your child is I really encourage you to to not shame yourself or your child, particularly as maybe your child's getting older, you know, you don't want to say, Oh, you used to do this when you were a baby. You know, it's time to grow up. Or, yeah, get over this. Get over it. Telling this to yourself like that is that is not helpful for yourself or for your for your child. And so to validate the fear that you're experiencing or your child's experiencing, and then to make a plan, I think is really, really helpful to help you get through this, the experience. Yeah,

Scott Benner 46:32
I'm just going through everybody's feedback on the Facebook group, which I can't say enough thank yous for, because these are really, these people really being honest here, you know, I mean, I've locked myself in rooms. I've have I've had irrational fears about needles my whole life. A lot of people do say like they passed eventually for them, which is, as they got older, I've had minor panic attacks. One person says their kid passes out when they do it. That just happens every time the kid, boom, just goes under. That's crazy. I've had needle phobias as a child. Back in the 1960s like this, this brought in people of all ages, you know, shapes and sizes, to make the to say that this has happened to them. I just think it's very important what you said before, just to not act like, oh, this doesn't really exist. You know, just because you don't feel that way doesn't mean somebody else doesn't.

Erika Forsyth, MFT, LMFT 47:22
Yes, and to this is emphasized from the MEG foundation for pain website that medical providers, they may only get seven to 10 hours of pain management training in their schooling. And so while they want to help you, and, you know, treat you the best you can, for you to feel comfortable, knowledgeable and empowered to ask for what you need. Now again, that says we're talking about, you know, when you're going into into the hospital or labs and then at home, for you or your child to feel the same way, to be educated, to know what's actually going through, to make sure they know what's helpful for them, I think is just is so important and was helpful for me to kind of refresh, to go through my memory, yeah, go through this like, okay, yeah, what is helpful for me and what is helpful for my children? You know, as we, as we face these different experiences with needles, the

Scott Benner 48:20
one thing that even I found like staggering, is the person in the group that said, like, I have tattoos all over me, but I can't give myself an injection. It's fascinating, really. You know, just the way some people react to things and others don't. I'm super happy we did this because you found Meg foundation for pain.org, which is a great resource people should go check out if they're struggling with this. I think whether you're an adult or a person trying to help a child, this would be a good website for you to look at,

Erika Forsyth, MFT, LMFT 48:45
yes, and you're so you're just, you're not alone. It is. It is so common. And I hope that, yeah, that you find some help in this or the other resources. Listen,

Scott Benner 48:57
I can just tell you from personal experience, it ain't no joke, some of Arden's reactions, I can't believe they're happening while they're happening. Like, like, really I I'm standing there, like, what is and it's so you brought it up earlier, like, I don't want to make this about me, but it's hard to be in the room trying to facilitate this thing. Like, you know what I mean? Like, when somebody says to you, no, I guess it's why I can't understand hurting another person, like, because when she's begging, like, begging for this not to happen, and I'm like, Oh no, I'm gonna do it not harshly, like that. Like, in your mind, you're like, No, we are going to get to the end where you are going to get this, and when it ends, you're not even going to care, which is, like, it's even hard to wrap your head around, because, like I said, five seconds after it's over, it's just over, but you're standing there, I feel like I'm gonna hurt somebody. I'm causing somebody distress. I mean, you're not, but it feels like you are. You know, you're having to do it for another health reason, but I don't know, but it's just of all the you know, diabetes sucks. I guess that's really what we should just say. Anything that makes you do this sucks because, but I hope you find a way through it. Like, I don't know how. Valuable we were we weren't the last hour, but I wanted to do this because I just don't hear anybody else talking about it, and I knew a lot of people had to be struggling with it. So here it is. I hope it's helpful. You can go find some resources to to get through it, or use Erica's idea, where you just take a Zanny and then everything's okay. People are gonna be like, hey, this lady, Erica, told me, and I just I took some wine. Now I don't have any trouble with anything anymore, being serious, like, if this was happening to you, like, this badly. What do you think the steps are like after you've heard all this and been through all this stuff? Like, what do you think the steps are that you would take for yourself if this happened

Erika Forsyth, MFT, LMFT 50:39
to you? So if I knew that I had trauma like, you know, severe medical trauma, I would definitely be really intentional in therapy, whether it was EMDR or CPT, to work through and reduce my association with that trauma, and then I would be really clear with what I needed to get through each site change or IV insertion. So if it was that level, right, I was just thinking about, you know, like claustrophobia, for people who are claustrophobic, I am for one, and I know if I were in a small if I had to take an MRI or something like that, or you're in, I can do elevators, but their treatment whether it's medication or coping skills. So I think to think about needle phobia like another really, we probably hear claustrophobia more often than needle phobia, but it's okay. It's okay to take medication, it's okay to go to therapy for this. It's okay to know what you need, and it's okay to advocate, so I would probably start with therapy. Know what my coping like tools are, and feel confident that I could use those. And if that didn't work, then you know, maybe it is taking a Xanax for a blood draw, but maybe you're okay with your site changes, but I think it's really practicing and trying out different tools and knowing what works, going

Scott Benner 52:04
back in my experiences, and looking back over the last however, many years, I do wish that we would have taken Arden to somebody to talk about I didn't realize that it was going to stick to her like this or that, and I think it maybe would have helped her to have, like, talk therapy around it when she was younger, even if it was just specifically for the needle thing, I think it would have been time, well, spent, you know, looking in the rear view mirror. It seems that way to me, at least. Well,

Erika Forsyth, MFT, LMFT 52:29
no, no shame or blame on you as the parent. You know, this is part of, part of the journey as a lot of parents have to go through. And it's never too late, right? Like, it's not too late, if she were open to that, yeah,

Scott Benner 52:41
sure. You go tell her. I mean, that's always the problem with getting people help on something like this is that you have to explain. They have to agree to do it, and it's not always that easy. Like I tried to I'm like, Hey, let's try grounding stuff. She's like, that's not gonna work. I'm like, Let's do breathing. That's not gonna work. I'm like, Arden, the stuff. People say this works for them all the time. She's like, Ah, just do it. But then at one point she's just like, she was almost begging. She's like, I we need to find a different way. And I'm like, Well, I don't want you to feel then there's the other side of it, like you're having a ton of medical, like, benefit coming from this thing too. So like you're trying to find the balance. So anyway, we called it, basically called it off for a couple of weeks. Now we're trying the pills that actually starts today, and then we'll see how that goes. And if that goes well, then great. And if it doesn't, then hopefully, maybe, just like I said, Maybe her situation overall in her life, feeling better might lead her to go, oh, okay, I could try this again. So but one way or the other, we got to figure it out, because she's not going to stop having diabetes anytime soon. So to me, this is just, it's the thing we have to figure out. So hopefully we can get her into a more accepting place. And then I'll bring up again, maybe going and talking to somebody about this, see if I can get her to the joke. I'm not going to give up, but it's a long process, is all I'm going to say, a journey. Yeah, they're sorry, yes, okay, well, thank you again for doing this with me. I appreciate it. You're welcome.

I'd like to thank cozy Earth for sponsoring this episode of The Juicebox Podcast and remind you that using my offer code Juicebox at checkout will save you 40% off of your entire order at cozy earth.com. That's the sheets, the towels, the clothing, anything available on the website, the conversation you just enjoyed was brought to you by us. Med, us. Med.com/juice, box, or call 888-721-1514, get started today and get your supplies from us. Med, I want to thank you so much for listening and remind you please subscribe and follow to the podcast wherever you're listening right now, if it's YouTube, Apple podcast, Spotify, or any other audio app, go hit follow or subscribe, whichever your app allows for and set up those downloads so you. Never miss an episode, especially an apple podcast. Go into your settings and choose, download all new episodes. Are you starting to see patterns, but you can't quite make sense of them? You're like, Oh, if I Bolus here, this happens, but I don't know what to do. Should I put in a little less, a little more? If you're starting to have those thoughts, if you're starting to think this isn't going the way the doctor said it would I think I see something here, but I can't be sure. Once you're having those thoughts, you're ready for the diabetes Pro Tip series from the Juicebox Podcast. It begins at Episode 1000 you can also find it at Juicebox podcast.com up in the menu, and you can find a list in the private Facebook group. Just check right under the featured tab at the top, it'll show you lists of a ton of stuff, including the Pro Tip series, which runs from episode 1000 to 1025 so.