You've Got a Lot of Nerve!

Probably more than me, anyway.

Yes, it's been a minute since I've written here. I blew a mental gasket, followed by the realization that I'd run out of things to discuss. I mean, it's a blog about diabetes. To come here and rant about politics or religion would be inappropriate. "In my next post, I'll tell you about my favorite science fiction novels." Not what this blog was created for.

Yesterday, 28 February 2023. however, brought something old/new to my life: confirmation of how bad my neuropathy really is.

Now I know it's been bad. In the last decade, I've gone from calling it "diabetic neuropathy" to "advance diabetic neuropathy." That's because of the diagnosis of Charcot foot. It takes a lot of nerve damage for bones to start drifting, suffer minor dislocations, develop microfractures, and eventually start fusing together. For some reason, knowing all of that didn't upset me all that much. It was an inconvenience. It sucked. But it had next to no emotional impact.

Yesterday was different. I went for a test called an EMG, also known as an Electromyography. Oh, if you're not taking care of your diabetes, get ready for this bundle of fun! They place a few sensors in various spots, and then send a pulse of electricity through specific points to measure the nerve and muscle responses. The test has two parts. The first is when they deliver little jolts through the surface of your skin. The second involves inserting a needle to measure electrical activity in various muscles.

The doctor and nurse would say late in my visit that I was their most fun patient. I tried joking about everything. For example, the doctor was Muslim and I was brought up Jewish, so when she had to deliver a particularly painful jolt several times, I blurted, "This is because I'm Jewish, isn't it!" And during the surface shocks, when the nurse was getting no responses, I had a whole shtick about the doctor berating her about wasting time by running the test on a corpse. "Living patient is in room two. Dead person room one. Go test living patient." (I used a Russian accent. I don't know why.)

Those lack of responses... When the nurse had to turn the electrode all the way up and was barely getting a response... I may have been making jokes, but jolting a nerve that hard and seeing a flatline was bad news. I'd had this test in the past and can't recall it ever hurting. I believe they use microvolts. When cranked to 100 and shocking the nerve several times, only to see nothing on the graph was disheartening.

Usually when I go have tests like this, I'm out the door when they're done and I get the results some time later. Not this time. The doctor was able to tell me that, yes, I do have carpal tunnel in my right wrist. Whether or not I'd benefit from surgery would depend on an orthopedic consult. As for my diabetic neuropathy... It's bad. Very bad. The doctor said, "There's almost no muscle left," but then immediately corrected herself, "Well, there's very little muscle left. You obviously still have enough to move your fingers."

You obviously still have enough to move your fingers.

There's some Stephen King levels of horror in that statement. Have you seen The Shawshank Redemption or read Rita Hayworth and the Shawshank Redemption? Those don't seem like horror stories, do they. You have to consider the author. King often seeks to find the worst fears a person could think of and use those fears as the basis for stories. Imagine being in the wrong place at the wrong time, with circumstantial evidence stacked against you, and because the shock of events has caused you to shut down emotionally, you seem cold and uncaring during the murder trial. A murder you DID NOT commit. You're found guilty and shipped off to prison, where you're promised three hot meals a day, a bed, and a whole lot of new friends you'd run away from if you had the opportunity. That's terrifying. That's what "Stephen King levels of horror" means.

You obviously still have enough to move your fingers.

Imagine the alternative. "You don't have enough muscle to move your fingers properly anymore." To an extent, I'm already there. Holding out my hand, fingers straight and held together, you'd notice that my pinkies and ring fingers on both hands can't close the space between fingers completely. When I struggle to try to make them do what I want, the fingers tremble feebly, refusing to do what my brain is telling them to do.

Dead muscles. Immobility. The muscles have atrophied, not because I was inactive, but because my brain couldn't stay in touch with my muscles.

The doctor DID compliment me for taking steps some time ago to find a fun way of working my hands as a form of physical therapy. I bought 460 2x4 Lego bricks for somewhere around $30. Almost every day, I take apart the last thing I made and build a new thing. Think there isn't much to be built with only one type of brick? Let's take a look.

You might be wrong.

So that's about all I have for the moment. This realization of exactly how screwed my hands are has been emotionally draining. And until I think of something more to say, or someone actually asks me a question about diabetes, this blog will return to it's suspended animation.

We're All DOOOOOMED! But Not Really.

It occurs to me that a lot of my posts are... Well, terrifying, if I'm completely honest. "This happened to me. That happened to me. It's going to happen to you." Etc. I try to emphasize that my complications are the result of not taking care of my diabetes when I was younger, and that you, my commentless audience, run the same risks. When - not if - they happen to you, they will probably happen differently.

That being said, let's all take a deep breath and consider this statement: "Diabetes is the healthiest disease you could ever have." It sounds like utter nonsense. "It's a disease, ya dummy. Diseases ain't healthy," you say to me. And you're right. Diabetes, however, is the one disease that makes healthy eating and exercise key parts of its management.

"But Rob... I'm like you. I'm so old that I'll be turning into crude oil on my next birthday." Well, I feel your anguish in that regard. If you're 40+ years old and have been diagnosed as Type 2, you might have had decades to develop poor eating habits, and the most exercise you get is lifting a fork to your mouth. Diabetes imposes a sense of urgency in changing those habits, and you should. But asking you to get a gym membership and overhaul your eating habits overnight would be unreasonable. (And yet doctors will ask, anyway.)

Allow me to make two immediately horrible suggestions on the dietary front. My go-to snacks are pork rinds and string cheese. (No, I don't peel the cheese. I bite into it like the savage that I am!) If you're a young diabetic, you can dig into these things as much as you want because - and here's the kicker - ZERO CARBS! Yes, pork rinds and string cheese have no carbs to upset your blood sugars.

BUT - and there's always a "but," isn't there? - these snack items are absolutely terrible for fat and salt content. Older diabetics need to be on top of those things, especially if a cardiologist has been added to the list of doctors you need to see regularly. The reason I get away with eating such garbage is because my cholesterol is under control and I haven't been retaining water.

"Hey, Rob... What about sugar free candies? I can eat plenty of those, right?" No... for a few reasons.

1. "Sugar free" does not mean "carb free." As bothersome as it is, look at the labels. Eating so many pieces equals one serving size, and that serving will have a carb count. It's annoyingly deceptive to make such things look like a good dietary replacement when they really aren't.
2. The cost. I don't know about you, but I'm not made of money. Sugar free candy comes in nearly microscopic packages and two or three times the price of a full bag of the sugary stuff. It's just not worth it, especially because...
3. They may have a laxative effect! Yeah, this one caught me off guard at one of the worst moments in my life. Mind you, I learned of this effect before it struck because I was bored and started reading the near-empty tin of some sugar free hard candies someone gave me. And right there, in the tiniest print possible, were the words: Caution! May have a laxative effect. That was not a good day.

Like my post made to Type 2 diabetics, diabetes mellitus is ultimately annoying in many aspects of its management. Reading food labels...? Utter pain in the tuchas. But it's also essential if you want to maintain good glucose control.

Now for the exercise. If you are young and slim, this shouldn't be too difficult. Heck, if you're older and slim, it's still not much of a problem. Remember that obesity isn't the sole cause of Type 2 diabetes. Just maintain an active lifestyle and all should be well.

If you DO decide to kick your exercise routine up, do it incrementally! A drastic increase while still taking your previously established medication doses could have adverse effects on your blood sugars! You could also hurt yourself if you try to do more than what your body is prepared to handle. Don't start with 100 pushups. Start with 10... then two sets of ten... then three... etc. Build your way up to it. Yes, you might feel a bit of pain initially. "No pain, no gain" and all that. But if the pain is extreme, LISTEN TO YOUR BODY! You're doing too much. Back down a bit. Obtain reasonable goals in a reasonable amount of time.

Or become a cyborg. Because cyborgs are cool.

For heavier folks... This is going to be rough. Your body is already struggling to carry the extra weight, so your true physical condition is a HUGE variable. I urge you to talk to your doctor about this! Y'see, I'M STILL NOT A DOCTOR! (Yeah, I know it's been a few weeks since I said it, but one doesn't earn an M.D. or D.O. in a couple of weeks, especially when not going to med school at all.) Instead of going right into an exercise regimen, your doctor may recommend physical therapy to get you started.

In fact, while I'm recommending seeking professional help, you should also probably consult a dietician about the changes you need to make to your eating habits. If you say, "Some guy in the internet suggested pork rinds and string cheese," I promise that you'll get disapproving looks from a dietician. 

The reason why my PCP hasn't complained about my dietary choices is because... Well, I've made it 48 years as a Type 1 diabetic and I'm still not dead, (despite my best efforts). My cholesterol is within normal range thanks to the statin I'm already taking. (A statin is for controlling one's cholesterol.) My Hgb A1c has been between 6.0 and 7.0 for seven or eight years, so I might as well keep on truckin' the way I have.

Try to keep in mind that this blog is meant to be educational and amusing, but that I'm not a medical professional. I could be a "professional diabetic," since I have decades of experience. But there's more to learn, and "doing your own research" on the internet can only take you so far. I'm not reading medical journals or attending lectures on new treatments. I'm hoping to educate and warn you against the consequences of mismanaging your diabetes, and hopefully make you smile along the way.

But if you'd rather "do your own research," then look up images of "diabetic foot ulcers." "Diabetic blisters." "Diabetic retinopathy." "Vitrectomy." "Charcot foot x-rays." Those images might bring more than an education than reading these pesky words. They might also include trauma, which is always fun, right?

This post became something of a mess, but that will happen when a dozen ideas pop into my head simultaneously. My main message is that you try to take immediate steps to alter your lifestyle, but it's okay to take two steps forward and one step back. As long as you're moving toward proper care of yourself and your diabetes, then all should be well... or at least better.

And now...

This... will take too long.

Hang on...

This is Jane Douglas. She is "YouTube famous," has a degree in physics, loves video games, and has a brilliant smile. I love her. She is my wife, even if she doesn't know it. In fairness, I've sent divorce papers to her in an effort to allow her to escape, but by addressing them to "Somewhere in England," I doubt they'll reach her.

(Jane, if you ever see this, please don't hate me for being silly. My blog isn't monetized, so I'm not using you in that regard. I'm using you to make me look ridiculous. But you are beautiful, and if an old troll like myself even stood a chance with a lovely woman like you, I'd at least ask you to... ummm... come over and help me clean my apartment, because it's starting to get away from me, and I could really use the help. 🙂)

The Best Bad Development Yet

Okay... I've mentioned several times that I'm overweight. It's reach the point that the moment when I mention that I'm a diabetic, there's that brief look in other people's eyes that sarcastically says, "You don't say!" Reflexively, I immediately follow up with, "Type 1 since the age of seven, not Type 2 as it appears." I might even gesture at the thing medical science calls a human body.

The weight came from my inactivity due to Charcot foot... and a few other sources. That weight I gained when I was taking that high dose of gabapentin, for example. I lost most, but not all of the weight. The utterly ridiculous situation where I sneezed and separated a rib from my sternum resulted in me being prescribed steroids, and the steroids caused me to put on 30 pounds. Unlike the gabapentin, I don't know why the steroids did it. Heck, I don't even remember the name of the steroids! I just know that when I was done taking them, I was bigger. 

At this stage of my life, once the weight is there, it doesn't come off unless there's A LOT of work done. I brought this up with my doctor, complaining that in a country like Japan, I'd be hospitalized, given a much healthier diet, subjected to physical therapy, and they wouldn't stop until I was no longer in danger of dying from weight-related causes. "What's a 'weight-related' cause of death, Rob?" Lugging around what could be considered the total weight of a separate human being, my heart could wind up saying, "Nope. I'm done." And then I fall over, dead from cardiac arrest.

It is NOT beyond the realm of possibility.

This isn't to say that I didn't try to lose the weight. I bought an inexpensive stationary bicycle, figuring that a one-legged guy could make use of it and not have to worry about dodging traffic. 

HOWEVER, there was a brief period when I did an incredibly stupid thing. I got lazy and decided it was a waste of time taking the shoe off of my prosthetic, and then have to fuss with it later when/if I had to go out. So I left the shoe on... but I went barefoot on the other side. The result was a wildly uneven gait, and my left hip was getting tilted at an increasingly painful angle.

I didn't seek treatment for this one because, frankly, it was embarrassing. Besides, why bother? I didn't need a medical degree to know I'd done damage to my sciatic nerve. My symptoms were a spot-on match for sciatica. (A pinched sciatic nerve.) The pain was pretty intense, but I chose to ignore it as best I could. Of course, I started removing my shoe from my prosthetic to normalize my gait, but it would take about six months for the pain to go away completely.

EXCEPT...! The damage to my lower spine from my weight gain, arthritis, and degenerative disc disease constantly put me at risk to trigger the pain again. Lo and behold, after assembling the stationary bicycle, I tried to get on it... and it felt like someone shoved a sword through my lower back and down into my leg.

Oh, I was never going to do THAT again, even if it meant that $150 was sacrificed to the gods of consumer regret.

What annoyed me most was that if it had been a regular bicycle, I would have been able to get on it. Because instead of having to contort my body to get my leg over the stationary bike's rigid frame, I could have lowered the bicycle and simply stepped over it to get my foot on the other side.

My weight, my spine, my amputated foot, and Charcot foot have made getting around extremely difficult. It's my weight and spine that come together to become the real villains of the story. Once I stand up, I have two to five minutes before I have to lean on something or sit to remove the intense pressure on my lower spine. My least favorite activity is washing the dishes, not because it's an annoying chore, but because the pain starts climbing... and climbing... until I'm standing there, panting and praying for death.

Now let me add some legislative stupidity to my life. Where I'm living, blood testing supplies can't be delivered by pharmacies. Why? Because smaller pharmacies used to submit claims for glucose testing supplies without actually distributing said supplies. After discovering that they were being defrauded, the government passed laws that required a signature from the patient or someone the patient knew in order to hand over the supplies. Mind you, this was only if a doctor prescribed them. Out of pocket, 50 of the test strips I use will cost around $35, and I need 100 to last me 25 days. And that's if I don't have any failed tests. (Failed tests are when you don't have enough blood in the strip for whatever reason; you couldn't squeeze enough out of your finger or managed to smear the blood instead of getting it in the stick.) 

The signature requirement made me NUTS! I couldn't get to my pharmacy by foot, even though it was technically a five-minute walk... if I COULD walk! By pure chance, one of the pharmacy delivery guys was also a diabetic, so he was willing to drop sign for them and drop them off after work. Mind you, he had to wait until he was off from work. Otherwise, it would be akin to the scam that got us in this jam to start with.

Additionally, there were other little things that were frustrating me. Like if I started running low on food, I couldn't go out and get more on my own, and I'm too technologically inept to do online shopping for local markets to have them deliver. There's a mall nearby, and I've never visited it because I can't walk. I've wanted to get a COVID booster, but those are only distributed by pharmacies for some silly reason. Thus, I have been trapped at home beyond the restrictions of the global pandemic.

After discussing all of this with my PCP, he finally agreed that I would benefit from a motorized mobility device and began the paperwork for me to get one.

Medicare, being the extremely friendly and helpful organization that it is, made this SUPER easy! No, wait. Hang on. I got that wrong. What they actually did was tell the one-legged guy that he had to jump through a few administrative hoops first.

The one that presented the greatest challenge was getting a physical therapist's assessment of my living conditions to PROVE that I would benefit from such a device. There are no PT specialists that do home visits in my area. NONE. ZERO! 

Enter the third party company that helps broken people like me get the equipment they need. A technician was sent over to take measurements of my apartment, and he then called a physical therapist and did a walkthrough of my apartment using the camera on his phone. (Ain't technology grand?) In the end, they said that I SHOULD qualify for a motorized device, but they wouldn't promise because Medicare likes to invent more and more hoops for the disabled to jump through.

Initially, I was rejected. But that's because someone forgot to check a box somewhere on the submitted forms. The next letter I received was acceptance. Yes, "Hop-Along Round-Man" qualified for the device. This was in May. Thanks to global supply chain difficulties, I could expect to receive it in September or October.

The waiting game began. Would I be a good boy and wait quietly? Not on your life! I called a month later for an update. No news. Okay. Called after another month. Still no news. Getting antsy, I called around 10 August, which was another month later, and not only was there no news, there was no nothing! There'd been no order status updates since my last call, which surprised them. The said they'd look into it and call me back.

When next they contacted me, it was to ask if I could accept deliver on August 31. YOU BET YOUR SWEET BIPPY I COULD! 

With the assistance of a few people more able-bodied than me, some furniture was moved around my apartment to make room for my new wheels. And here they are!

I'm gonna go cruisin' for chicks with

this baby!

Now you're saying, "Rob. This is great! You'll finally have the freedom to do stuff!" And you're right. But I also feel like this is the final flag that's declaring me crippled, (as though the near-countless other reasons didn't do that).

~ sigh ~ I need my beautiful, scantily clad young woman. Where is she?

There she is... but annoyingly

overly clad.

NOTE: I don't know if anyone's noticed, since y'all never leave any comments, but I've essentially started making posts every other day. I think if I went with daily entries, I'd run out of things to talk about too quickly. This one is posted off schedule because of the date it occurred.

Saga of the Foot - The Aftermath

You're back! And it's time to see justice done! My literal flesh had been sacrificed to the negligence of a group of arrogant orthopedic surgeons, as well as a significant amount of my mental health. Through it all, my mind was locked on the idea that I was going to sue those doctors into non-existence. They crippled me even further with their inaction. My foot had to be worth millions! MILLIONS! 

As I started the healing process after surgery, I began the quest online for a lawyer who would take my case. They get a nice percentage of the settlement, so surely a case worth millions would be worth their time. As I found them, I would call them.

Well, my friends, I gave up after talking to at least a dozen different law offices. No one - and I mean NO ONE - was going to touch my case with a 10 foot pole. 

I'll start with the lesser of the two reasons. You see, I was already disabled when I lost my foot. Being on Social Security Disability meant that there was no loss of earned income. That meant that that side of any lawsuit would be worth exactly zero dollars.

The other reason...? I'm a diabetic. Any attorney working to defend against my lawsuit would argue that diabetics suffer amputations all the time and that there was no way of truly knowing the cause of my loss beyond my illness. One lawyer said, "I'm not saying that what you suffered wasn't catastrophic. I'm saying that it would be impossible to win against what is considered common knowledge." My diabetic neuropathy had advanced to the point of Charcot foot. Who's to say an amputation wasn't waiting just around the corner in a month or two?

Talk about a gut-punch. The steady stream of rejections was translated horribly by my severe recurrent depression. "I am literally worthless." Hells, I wasn't even worth the sum of my base elements! THAT, dear reader, is one hell of an insult.

Enter chronic insomnia. I would lie in bed, stewing over the fact that a pair of doctors were going to get away with causing a literal loss of limb for me. I would vacillate between nearly uncontrollable rage and a bottomless pit of despair. Sleep would only come when my eyes swelled shut from exhaustion. The doctor I was seeing at the time went with the old insomnia standby, Ambien. But I turned out to be one of those people whose brain was put into overdrive when taking it. Want to be amused? One of the side effects of the sleep medication known as Ambient is insomnia*. 

My current physician - bless him - recognized my need for something that would shut my brain OFF! Now I'm eventually going to discuss the uses of narcotics when addressing chronic pain, but I'm going to use this doctor and this prescription to exemplify communicating honestly with your doctor!

The prescription is Xanax. (It's generic name is too long to type.) It comes in 0.25, 0.5, 1.0, and 2.0 mg. doses. The pills are also scored, meaning that they have a line in the center that allows you to split them. Pills that don't have scoring should not be split! (Consult your physician or pharmacist if you have any questions about prescribed medications.) My PCP initially prescribed 60 tablets of the 1.0 mg. dose to be used twice a day as needed. This prescription would last me well over two months because... Well, I didn't really need that much.

During a visit with the doc, I told him that I was using half a tablet at night - only 0.5 mg. - and occasionally trying to split the halves into quarters for a 0.25 dose during the day. It's that second part that was a little wonky. Even with a pill-splitter, those quarter-tablets would be randomly sized. Maybe I was only getting 0.15 mg. in a daytime dose. Maybe it was 0.35 mg. I had no idea. Because this is a habit-forming narcotic, I didn't like that I was taking an unknown dose, regardless of how small.

As a result of our discussion, the prescription was reduced to 0.5 mg. tablets that I could easily split by hand down to 0.25 mg. should I need something during daylight hours. That quantity of 60 tablets tends to last 45 days or more.

If you are dishonest with your doctor or withhold information that's vital to your care, you could wind up with the wrong medications, improper doses, ineffective or damaging treatments, or worse. "Worse," in this case, equates to "death,"

Now before I go, I don't know if you noticed the * at the end of my Ambien tale. That's because it brought to mind something I ultimately found very funny. They've since removed it, but according to the insert for Humalog, one of the signs of severe hypoglycemia is DEATH. Death... was just a sign... of low blood sugar. This knowledge led me to suggest that if anyone ever ran across a corpse that they should try giving it a candy bar. There's that slim chance that that's all they needed to live again. 🤣

That's all there is, folks. No one paid the price for medical malpractice. My would-be lawsuit was rejected for the simple fact that I'm a diabetic. Which means, as per my usual luck, the light at the end of the tunnel for me was...

At least it's not an oncoming train, right?

Saga of the Foot - Part 4

Wow. You came back, even after what I showed you last post? I commend you for your bravery. Unfortunately, it doesn't get better. Sorry about that. 🙁

And while I'm at it... WARNING! There will be more disturbing images of my foot in this post!

Okay... I was off to see a new wound care professional. When asked if I'd been treated previously for the wound, I said yes, but refused to give any information about "the school nurse." I wanted a completely fresh assessment of the wound without it being tainted by the doctor that had started giving me nightmares. And the new doctor's assessment brought a heightened set of old anxieties.

His theory was that a chronic infection had latched itself to the hardware in my foot. As it was explained to me, infections that became attached to hardware were next to impossible to cure. If that was the case, they could TRY to remove the hardware and any infected tissue, but the aftermath for someone with Charcot foot is that the interior of the foot would simply collapse. His advice...? Lose the foot and get a prosthetic. 

My very first second opinion opened with amputation as the recommended treatment plan.

However, he wasn't about to have me run off to have my foot removed. Instead, he set up a consultation with an affiliated orthopedic surgeon... who was on vacation for the rest of that week, of course.

I count the surgeon as my second second opinion. He used the words "cautiously optimistic" several times during my visit, meaning that he was hoping there'd be a chance I could keep the foot, but he didn't want to make promises he couldn't keep. What's more, he deemed my case so serious that he wanted me on the operating table THE NEXT DAY! 

There was a present waiting for me on the day of surgery: a nerve block. Once applied, I could feel absolutely nothing below my knee. I was gloriously pain free for that time! Mind you, they told me that it would only last for 12 hours, so when it didn't wear off after that, I panicked and thought they'd damaged the nerve. A few phone calls later, I learned the time limit was actually 40 hours and calmed down.

The results? Well, the surgeon cut away the entire lump on the underside of my foot. There's no picture, but I can make up for that with a description. I had a hole that was a perfect circle on my sole that was 2 inches in diameter. The inside looked like ground beef. And in the depths of the wound, the surgeon found... MRSA! That's the super bug I've described previously. The special specialist and the school nurse had all failed to go deep enough to find the infection. I was put on oral antibiotics for 21 days. Daily wound care nurses would continue. And with any luck, I would heal properly... unless the source of the MRSA was the hardware. If that was the case, this thing was never going to heal.

DRAMA ALERT! DRAMA ALERT! DRAMA ALERT!

In the weeks that followed this surgery, my life exploded. My ex planned to go to a gaming convention with friends. Her life became all about this event. A month before she was to go, she did something that finally made me realize that being with her was a monumental mistake. With this realization came a series of phone calls to have friends come rescue me from her. (Remember, no details about that nightmare relationship beyond how it affected my foot unless it's asked for.)

While I was coping with the twin disasters that were my feet, our apartment became such a catastrophic mess that she didn't even notice when I packed all of my belongings! Mind you, it took me the next 30 days to finish packing what few things I owned because of the giant hole in my foot. And it wasn't until the day before she left - with everything paid for and her solidly committed to going - that she finally asked if I'd be okay without her for a few days. 

Oh... There was one other thing that made my plan to leave her without advance warning acceptable in my eyes. She'd been telling me that she was going to leave her engagement ring behind because she "didn't want anything to happen to it." Translation: she was going to cheat on me and didn't want the ring around to remind her that she was supposed to be in a committed relationship. I took the ring with me when I left.

At a new location, I had to rush to find wound care. I got that taken care of with remarkable speed, leading to my third second opinion at yet another wound care clinic. They'd try to heal the wound, but they were a lot less optimistic. Their opinion was that it was probably best if I had the foot amputated and started the healing path in that regard.

Then came the podiatrist I had to see for basic foot maintenance. He was second opinion number four! He said that even if it healed, there was a better-than-average chance that it would happen all over again.

Finally, second opinion number five. I went to see a new orthopedic surgeon. By that time, I'd been trying to heal the crevasse in my foot for a year. Brace yourselves again. You'll get the picture of what it looked like at the start and what it looked like just before the amputation.

What it looked like at the beginning.

What it looked like a year later. And that

blurry, handsome devil in the background

is me. Try not to swoon.

Simply put, I wasn't healing. Not completely. If ever there was any progress made, it would be undone in short order. "Two steps forward, two steps back." It was a no-win proposition.

There was one good thing about this horrific scenario. I'd had a year to get used to the idea that I was going to lose the foot, which is a lot better than most people. I also had people around me with twisted senses of humor. So this is where the real jokes start to fly!

But they'll have to wait. That said, I've tortured you with two really grotesque pictures of my ex-foot. I know I've been teasing you with the beautiful, scantily clad young woman. Well, here she is!

Her smiling face, anyway.

Saga of the Foot - Part 1

Yeah, I've decided to brave this subject. I promise you, there's humor woven into the story, but it's not instantly apparent. This story is also the culmination of things I've written about before, so expect a degree of repetition. I'm not repeating things to bore you. I'm repeating things in the hopes of drilling them into your head. 

It's better that I use words than an actual drill, isn't it?

First, let's take another look at a normal foot x-ray. Keep in mind that I searched for one that I could look at without asking, "What the heck is that?!?" Really, "normal foot x-ray lateral view" brought up images that did NOT look normal. Remember, I'M NOT A DOCTOR, but having seen what MY foot looks like, I can basically look at what they considered "normal" and say, "No, something's wrong in there. Here's hoping whoever labeled this for the internet wasn't that person's doctor."

As normal a foot as I could find.

Now let's look at my feet.

Right foot. I'll explain the circles.

My left foot. I said I'd explain the circles!

Don't rush me!

Yes, the left foot is post op of my second Charcot reconstruction. It can't be helped; they're all I have left. The smaller circles are around genuine bone spurs. On the left, it formed a kind of hook. On the right, it looks like an upside down shark fin. As for the bigger circles, those are the collapsed arches. These latter deformities were visible without x-rays, presenting as rocker bottom feet. Just imagine the sole of your foot curving like the runners of a rocking chair.

My complaint to the foot and ankle specialist I was seeing at the time was that the bone spurs were starting to become a problem. I was developing painful scar tissue under them. I would take a step, the bone spur would first land on the scar tissue, and a split-second later the spur would slip off the scar tissue and stab into the tissues that hadn't scarred.

The doctor's observations were that the fused bones in both of my feet were stable, so he could go in and do some plaining on the bottom of my feet. I needed the spurs addressed, but he sold me on addressing the collapsed arches while I was already in the operating table. Kind of like how the car salesman sells you on upgrading the sound system in your car for an extra $1,500 when you're not even a die hard audiophile.

NOTE: I'm not sure if it should be "plaining" or "planing," so I'm going with the former because a plain is a flat piece of land with few trees. As far as I know, there were no trees growing out of my feet.

So it was that I was scheduled for bilateral foot surgery. This meant that he would operate on BOTH feet simultaneously. I was a little worried about him messing with both feet at the same time, but was assured it could be done and I wouldn't be in excruciating pain. And he was right. I wasn't in excruciating pain... yet. 

Of the surgery itself, he said the most shocking thing he encountered was the amount of scar tissue he encountered along the collapsed arches of my right foot. It was so thick and tough that he initially thought it was bone!

Doesn't this all sound like fun? Some of you may be saying, "Damn, Rob. Sounds like you went through Hell." Alas, you're missing the point if that's the only thought you're having. I'm not telling this story for entertainment. I'm trying to warn you that THIS COULD HAPPEN TO YOU IF YOU DON'T MAINTAIN CONTROL OF YOUR DIABETES! Probably not exactly as it happened to me, but something very similar.

Now for a slight divergence in this story because I have to tell you about my ex. I could write an entire book about the things she did and didn't do, but the two things you need to know about her was that she worked at the nearby hospital cleaning operating rooms and that she showered once every two or three weeks. 

Yes, it WAS disgusting! She got away with this at work by applying deodorant and body spray before leaving our apartment. But by the time she got home, she STANK! What's more, she would get mad at me if I pleaded with her to shower.

Why is this important? Because my ex was working in a bacteria rich environment and not washing it all away on a daily basis. You see, hospitals are something of a contradiction. They have staff dedicated to keeping everything clean, but bacteria-laden patients are in and out all day. Those hard-working cleaning staff members are always playing catch-up. As a result, my ex was bringing home all sorts of microscopic ugliness and allowing it to grow.

What happened to me next might be entirely her fault.

A few weeks after my surgery, it was becoming impossible to walk on my left foot. It hurt so damn much! I wasn't about to fiddle with my bandages, but the pain reached a point where I had to take a look and find out what was going on.

What I saw instantly filled me with horror! It looked like I'd somehow inserted a golf ball into the sole of my foot. The entire area was covered in clear fluid and the skin looked pale and lifeless. Seriously, my mind immediately leaped to the idea that necrosis was next. Thankfully, I was wrong. The skin was merely macerated, meaning that it has been saturated in fluid. (Don't worry. You'll get an excellent view of macerated skin in time.) But when I called my doctor's office, I was in tears, convinced that if I went to the hospital that I was going to lose the foot.

The hospital was exactly where I was told to go. By the time the office returned my call, which was in under 15 minutes, I'd come to realize a couple of things. Whatever was leaking from my foot wasn't pus and there was no bad smell coming from my foot. The thing that always comes to mind when I'm fretting over possible infections is a moment in Saving Private Ryan. A medic asks one of the Army Rangers to smell a patient's leg and tell him "if it smells south of cheese." Since my foot didn't smell cheese-like at all, I was less panicky.

I was still worried, though. Pain and excessive swelling are two of the things that post op patients are supposed to report immediately to their doctor, and I had both of those in spades!

Here, dear reader, is where I'm going to end this part of the story. Why? Because my hospitalization was something of an adventure unto itself. And, no, you don't get even the tease of the beautiful, scantily clad young woman. You already have three sexy x-rays. Don't be so needy.

It Runs Deep

Boy-howdy, did you get lucky! When I sat down to start writing this post, I had decided to dive into the deepest, darkest waters of my life and tell you about the loss of my left foot. But as I settled my two fingers on my keyboard, (I'm a two-fingered typist), it occurred to me that a major topic would be missing from that story: Infection. Oh, I've mentioned how serious infections can be, but I haven't explained nearly as much as I can.

So buckle up, buttercup! We're going for a ride!

But fiiiiirst... Seriously, you Earthlings reading my ramblings, do you  really have nothing to say?! "Wow, Rob, I'm so glad you told this story! I had no idea this was even possible!" "Rob, for revealing the previously unmentioned and horrific truths about diabetes, I curse you and all who know you." "You write good." "I don't know who you are. I don't know what you want. If you're looking for money, I can tell you that I don't have money. But what I can tell you is that I have a very particular set of skills; skills I have acquired over a very long career. Skills that make me a nightmare for people like you. If you let my diabetes go, that'll be the end of it. I will not look for you. I will not pursue you. But if you don't, I will look for you; I will find you; and I will kill you." (Anyone catch what I did there?) Seriously, folks, I would appreciate the feedback. Heck, I'll even accept, "Show the scantily clad, beautiful young woman already!" (And give up on a running gag so easily? You'd have to comment to see if I'd actually do it.)

Back to our regularly scheduled blog post.

Infections are troublesome for Type 1 diabetics because we start off being immunocompromised. It means our immune systems don't function properly from the beginning. But then Type 1's and Type 2's experience overlap once diabetes has affected them at a microvascular level. It's important to remember that excessively high sugars alter the structure of blood vessels. The stranglehold in the smallest parts of your circulatory system means blood can't flow properly to wounds to heal them. As a result, we're more susceptible to infection.

Yes, I've mentioned the vascular disease before. And I'll mention it again whenever necessary so that you understand exactly how important it is. That applies to monitoring your blood sugars and communicating with your doctor.

Y'know what else I've mentioned that you may have forgotten? How deep an infection can get. An infection on your skin can wind up going down into your bones! And a bone infection is called osteomyelitis. 

I've had it twice.

The first time I had it was the result of an obnoxious ER doctor who didn't see me as a diabetic in pain. He viewed me as a drug-seeking lowlife.

Look, I can understand that he had probably encountered drug-seekers. They say they're in pain, but have nothing to show for it. I, in turn, had a lump in the middle of the ball of my foot. After getting an x-ray that showed nothing, he numbed me with a local anesthetic and used a scalpel on the lump.

The ER doctor... sliced open the underside of a foot... of a 38-year-old man... who'd been an insulin dependent diabetic... for 31 years. (Those are the numbers for the summer of 2005.)

Nothing but blood came out. The only things he had to go on were the facts that I said I was intense pain and that there was swelling. So he did two things. He flat out told me he wouldn't do ANYTHING for my pain and he discharged me. That's it. And he did these things as rudely as possible, making it very clear that he thought I was faking so I could get drugs.

Two weeks later, I was back in the ER with what seemed like the same complaint. Except this time the x-rays showed that the third metatarsal of my right foot, right at the point where the other doctor had cut me open, was infected. I was immediately admitted and kept for 27 days. Every day involved a twice daily bag of vancomycin, which is an antibiotic, and the occasional test. X-rays, bone density, MRIs. The x-rays were the best! Each showed more of that long bone in the middle of my foot slowly disintegrating. Eventually, there was so little of the bone left that I experienced a pathological fracture. That's officially defined as "a broken bone caused by disease." 

Once I was discharged from the hospital, I still had to administer the IV antibiotic. Getting that set up was its own form of fun. Their first two attempts were PICC lines. That's a Peripherally Inserted Central Catheter inserted in the forearm. The line was pushed all the way up my arm and into the chest region. They took an x-ray to ensure it was positioned correctly, and then the plan was to send me home with a two-week supply of vancomycin.

But by the time I returned from the x-ray, the skin covering my bicep was covered with a splotchy red rash and was tender to the touch. They'd never seen anything like it. I mean, it was obviously an allergic reaction, which they'd seen often enough, but the PICC line was made of the same materials as the IV lines they'd been putting in me for weeks, and I'd had no reaction to those in any way.

Those jerks at the hospital tried to get sneaky with me. They removed the first PICC line, inserted a new one in the opposite arm, and did their best to rush things along so they could have me out the door before I had another allergic reaction.

This is where I'll bring up The Patient's Bill of Rights for the first time. Here are the basics:

1. The right to be treated with respect and without discrimination.
2. The right to obtain your medical records. (Keep in mind that many doctors' offices will charge you for the resources used to make copies.)
3. The right to privacy of your medical records. This is compliance with HIPAA. 
4. The right to make a treatment choice. As long as you're of sound mind, YOU decide what can and can't be done to you. Which leads neatly into...
5. The right to informed consent. You need to have tests and procedures explained to you in a way that you understand. This is why you'll find yourself signing a form saying that you consent for a doctor to treat you.
6. The right to refuse treatment. Again, as long as you're of sound mind and understand the consequences, you can refuse tests, treatments, and medications.
7. The right to make decisions about end-of-life care.

The attempt to rush me out of the hospital brought 4 and 6 of those rights into play. After racing to insert the PICC line, get their x-ray, and shoo me out the door, I availed myself of my rights and refused to be discharged. I insisted that we wait to be sure I didn't have the same allergic reaction, and I was glad I did! About an hour after refusing to let them release me back into the wild, the splotchy red patch and tenderness appeared on my arm.

So it was that I underwent a minor surgical procedure to install a Hickman catheter. This was put in my chest and anchored in my jugular vein. Same materials as the PICC lines. No allergic reaction. Don't ask me. I never received an explanation of how or why my body reacted like that.

Come the next day, which was the 27th day of my visit, I was sent home.

When the bone eventually healed completely, there was a visible deformity at the end of the bone that even I, without medical training, could pick out. But thanks to Charcot foot, all of the bones look deformed.

I was lucky. Very lucky. The treatments for osteomyelitis are:

1. IV antibiotics.
2. Surgical resection of the infected bone and IV antibiotics. This means that in addition to medication, they surgically cut away necrotic or infected bone. ("Necrotic" tissue means it's dead.)
3. Amputation.

It all depends on a number of factors. Patient age, medical history, severity of the infection, etc. If ever faced with this fairly scary illness, be sure to have an in-depth conversation with your healthcare team. There may be tight time constraints if the infection is endangering your life, but if you can be afforded the time, write down any questions you might have so you can remember everything that has come to mind about the literal loss of a limb. "Informed consent," remember? 😉

Okay... We'll start my second osteomyelitis story with some audience participation. Extend a finger, then use your other hand to move the finger in a circular motion by its tip. You'll notice that the entire finger moves. This is because of the tendons running the entire length of all of your fingers. This simple principle applies to your toes, too. There are no muscles in your fingers and toes. It's basically held together with skin and tendons.

What happened to the second toe of my left foot remains a mystery. I couldn't recall ever injuring it. For whatever the reason, I had what could best be described as a "volcanic wound." It looked like pressure built up inside and it blew its top, leaving a small hole at the tip of the toe.

Two things stood out from the examination by my podiatrist. (A podiatrist is a foot doctor.) The first was that he was able to get the wooden tip of an applicator into the hole and slide it down to the bone without any obstructions. The other thing was his ability to move the tip of my toe independently of the rest of the toe. Because there are no muscles in toes, it meant that the tip of my toe was basically being held in place by skin, and only skin. Oh, maybe some other tissues exist in there, but I couldn't tell you for sure. (I know it's been a few posts, but in that time I STILL HAVEN'T BECOME A DOCTOR!) Whatever the infection was that had gotten into my toe had eaten away the tendon. It was well within the realm of possibility that I could bang my foot into something, remove my sock to inspect the possible damage, and have the end of my toe fall out of the sock.

A second opinion wasn't necessary. I could see that the toe was done for. An x-ray was taken, but it revealed nothing because... Okay, this is going to be hard to grasp, but an x-ray of an infected bone is always two weeks behind what can actually be seen on film. The only way to get an up-to-the-minute status of osteomyelitis is to open the patient up and examine the bone visually. And that seemed like a lot for a toe that was obviously on its way out.

That particular podiatrist was a very likeable guy, and he often preferred to understand a patient's illness to some extent than dismiss it once it had been addressed. So after my toe was removed, it was sent off for a pathology report. I've already revealed that it turned out to be osteomyelitis, but the lab labeled it "site specific osteomyelitis." What does that mean? No idea. Even the doctor didn't know. His takeaway was that it was a bone infection, so the mystery was as solved as it could be.

I would like, however, to note that I tried to look up "site specific osteomyelitis" so I could give you all some kind of definition. This proved to be a monumental mistake. Pictures of diabetic feet with advanced infections are worthy of nausea. And when I get to my own foot amputation tale, you'll get an eyeful of nightmare fuel.

Thus, my lengthy post about osteomyelitis comes to an and. I would go through my shtick about the young woman, but I'm going to see if I can coerce you people into commenting. And to that end...

I'm all ears.

Diabetic Neuropathy: Charcot Infested Waters

Welcome back! In this post, I'm going to talk about my favorite complication of a complication of diabetes. This one is so special that it gets a name that doesn't include the word "diabetic." Diabetic retinopathy? Diabetic neuropathy? Diabetic nephropathy? Amateurs compared to CHARCOT FOOT! "Charcot" is pronounced "shark-oh." Hence my punny title. Delving a wee bit deeper into medical technobabble, it's also called Charcot arthropathy. 

This post is going to be a real treat, as you'll finally get to see what truly lurks inside me, your charming, humorous, and handsome author.

Charcot foot is a condition that's considered an advanced form of diabetic neuropathy. It's also another one of those diabetes complications that have theories about its cause, but no solid facts. (It's why doctors "practice medicine." When they finally get it all figured out, they'll probably stop practicing and go pro.) The way I describe it is thus: Because the brain has stopped talking to the soft tissues in your extremities, they stop doing their jobs, resulting in the bones of your foot starting to drift, suffering microfractures and dislocations. 

Within two years of my diagnosis of Charcot foot, the arches of my right foot had completely collapsed, and my left foot was turning into a deformed mess that wouldn't support my weight without significant discomfort. 

I endured Charcot reconstructive surgery on my left foot TWICE! The first time, four screws were put through the bones of my ankle to help them fuse together. Fused bones don't drift or experience those miniscule fractures... or so we could hope. This surgery took four hours. Basically, the doctor had to open up the entire ankle to see what he was doing, and then drill those screws into place. Post-op was three solid months of absolutely ZERO weight-bearing on my left foot, and another three months of only partial weight-bearing.

Oh! I forgot something about the surgery! Not sure how I managed to forget this aspect, seeing as how it was so impactful, but IT FREAKIN' HURT! Medical professionals like to ask, "On a scale of 1 to 10, how would you rate your pain?" When asked during my post-op hospital stay, I wanted to scream back, "IT'S A THOUSAND! DON'T BRING MORPHINE! BRING CYANIDE!" 

My doctor was impressed with how well I healed afterward, and the bones of my ankle were fusing nicely... until he noticed that the metacarpals - the long bones of the foot - in my left foot were starting to drift outward. He wanted to go back in, remove the screws, and install three long bolts in an effort to get my entire foot to fuse.

This, my friends, is where I uphold my promise from earlier. I present to you... the real me:

Profile of my left foot post-op.

Top down, angled view post-op.

The nurse said something during a follow-up visit with the surgeon that I found a bit unnerving. "It's fascinating being able to see everything in a foot by using just a bright light." The way you can kind of see the bones of your fingers with a flashlight, she could see inside my entire foot.

My adventures with my left foot would continue, but that's yet another one of my stories that will have to wait. For now, we'll move on to my right foot. I lucked out. My surgeon had initially wanted to reconstruct it, too, but the bones eventually fused on their own and the foot was stable. I'll even show you!

This is obviously not my

foot. I simply wanted

you to see what a normal

foot should look like.

The mess that is my

right foot. You don't even

need to be a doctor to

see the difference!

My right foot becoming deformed did two things. It caused my Achilles tendon to constrict, requiring surgery to lengthen it. While not making my right foot completely mobile, it did double my range of motion. Charcot foot also altered my shoe size from 10.5 down to 7.5.

More podiatric adventures await, dear reader! Thrills! Chills! Spills! No, really. I once took a messy fall when I kinda sorta forgot I was disabled. But those tales are for the future! For now, I leave you with the beautiful, scantily clad young woman!

Hmmm... This one seems to be wearing a mirror.