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. 🙂)

A Little Update

Did you read my last post? Did you recommend to a friend? Did you leave a like? Did you subscribe? DID YOU COMMENT?!? If you didn't do any of those things, then you are giving me cancer! Social anxiety cancer or something. And the only thing I know that people actually CAN do is comment.

The thing is, if my audience remains small and unresponsive, I'm going to start questioning my reasons for writing. I'll keep going if I KNOW I have been and still am helping at least one person, but if the views my blog is getting are from people who are actually bringing up my blog  by accident, then working toward a post every other day isn't going to feel good. This will go from a desire to do good in the world to feeling like actual work, and no one is paying me for what started out as a labor of love.

And now for the update mentioned in the post's title. I posted pictures of the skin, or lack thereof, from the diabetic blister I experienced. Well, here's a look at 10 days worth of healing.

What it looked like the day after

it happened.

A week and a half later.

I'm actually glad I took the photos, as I can now chart my own progress in healing. You can see healthy skin growing in, the area of the original wound visibly shrinking. The oddities you may notice in the second picture... That horizontal line is from the ace bandage I've been using to keep gauze in place. I didn't want to risk tape pulling away more skin. And the blue socks with the white print are the non-slip socks they give patients at hospitals. I have several pairs that have followed me over the years, and I sometimes wear them over my white socks to prevent the whites from getting dirty when I go downstairs to check my mail.

That's it. I'm sneaking this post in just under the wire. In 10 minutes, the 16th will become the 17th.

Please... I know I'm coming across as thirsty for validation, but it's needed. Say something so I know if my scribbling is reaching someone who values it.

Please Like, Subscribe, and Comment Below

Greetings and salutations, internet denizens! I am... goin' through it, y'all. Whenever a complication of my diabetes becomes the focus of my life, it's like my emotions are wearing cement shoes and have been dropped into the Hudson River. 

That giant blister, for example. I may have an alternative method for getting cleaned up, but it's hardly a replacement for a good shower. And the timing could have been better. I need a haircut, but I can't cut my hair until I have the capacity to properly rinse away all of the stray clippings. When my hair gets long enough, the sides start growing upwards into what I call "horns." It's silly and annoying.

Alas, "silly and annoying" is what eventually gets me down. The blister site stings at random - probably a combination of diabetic neuropathy and the fact that I've lost a few layers of skin. I have to change the dressing daily. I have to go out and buy more wound care supplies because I have to change the dressing daily. These are not the normal interruptions one would expect in adulthood. I should be annoyed that I have to go to the supermarket because I'm running low on vegetable spread, not 4x4 gauze. And insurance doesn't cover basic first aid supplies, so it's an out-of-pocket expense that I really can't afford.

So I come here and write about my experiences. I share in the hopes of educating others so that they take proper care of their diabetes, or to help non-diabetics learn what their diabetic friends and family have to face. Their experiences will be different from mine, but the mechanisms beneath my complications are the same as theirs.

That said, SOMEONE is reading this blog. Sometimes the analytics crack double digits, and that's VERY exciting. I've asked for feedback a few times, and thus far the response has been nonexistent. Like every human on the planet, I need a little validation. Heck, it's not the validation, it's human interactions that I crave! Tell me I'm doing well. Tell me I could be doing better. Tell me I'm doing terribly. Correct information I may have gotten wrong. Share YOUR experiences with diabetes. Or... 

ASK QUESTIONS. The all caps, italicized letters are my way of saying that I'll answer just about any question put to me. I can be honest to a fault, which some people find unnerving, while others find it refreshing.

I've tried to promote this blog so it reaches more people who may need the information within. That personal experience with dollops of humor mixed in. Unfortunately, I don't actually know HOW to promote it. The best I could do was ask a few YouTubers to read the first few entries to try and hook a few more readers. 

But you know what YouTubers are absolutely TERRIBLE at? Replying to e-mails. I end every message with a request that they at least acknowledge the e-mail, even if it's with a "Thanks, but no thanks." 

Nothing. 

That's how I wound up with this post's title. They're always for likes, subscribers, and comments, and it seems to work for them. So maybe it'll work for me. And, you know... Maybe a couple of recommendations from my readers. 😁

Finally... While there are more risqué pictures of the beautiful young woman, you may finally see her "scantily clad." It's a bikini, but still.

Now it's just a matter of someone

convincing me to post a pic of her

in lingerie. 😉

Disaster Supplements

Oh, have I got a treat for you! It's the wounds on my legs! That's right! I've decided to let you bask in the glory of the nonsense I have to deal with. These pictures are fresh from this morning. And remember, all this can be yours for the low, low price of ignoring your blood sugars!

I'll start with the wound that started this adventure almost two weeks ago.

It's a terrible angle, but that little line near the bottom started out as a crusty scab that was looking somewhat annoyed. Keeping it clean. Keeping it covered with antibiotic ointment and fresh gauze. Taking the antibiotics as prescribed by my PCP. These actions have it looking pretty good today.

BONUS WOUND! This little guy higher up on my shin is from the components of a shelving unit falling on my leg. This was one of those wounds that I felt and treated immediately. Because I received it at the tail end of the antibiotics I was already taking, infection didn't really have a chance to settle in.

This is the section of skin that peeled away when I removed the taped dressing a few days ago. Mmm! Looks deliciously moist, doesn't it? And just look at that discolored flesh from wounds in the same spot repeatedly! I tell ya, it's a wonder I can keep women from climbing all over me!

And now... for the absolute... without the shadow of doubt in my mind... dumbest development yet!

Yup. I accidentally managed to make it bigger. All I did was gently probe to see if there was still fluid buildup around the wound and the skin simply sloughed off! You can see a small fold of skin. It was so soft that it was a miracle the skin was attached to me AT ALL! 

Do you know what this means? It means I CAN'T SHOWER! Not until I've done about a week of decent healing. "But Rob... Why can't you shower?" Because the skin has become almost inconsequential, barely performing its function, and softening it further in the shower risks removing even more. If I had two feet, I could cover the area with a trash bag and seal it higher on my leg, where the skin is healthier. However, I sometimes have to stand on my remaining foot in the shower, and the bag would create a fall risk too dangerous for a guy living alone.

Thankfully, I have an alternative method of staying clean. Hospital grade antibacterial wipes. They'll at least keep me from being followed by a cloud of stink wherever I go.

That's it, folks. No funny pics or teases about beautiful women. You got four pics of my "sexy" wounds today. No, no... You don't have to thank me. It's a service I'm only too happy to provide free of any cost to you.

Look, Honey. Another Disaster.

I have a completely different post all ready to go, but events from yesterday and today have prompted me to write about how damnably frustrating the complications of diabetes can be.

This tale actually starts about 12 days ago, when a friend took me to do some food shopping. It's easier to do by car, and I haven't driven since being declared disabled decades ago. While we were out, something caught my eye on the floor, and when I looked down, I discovered a cut near to where my foreleg meets my foot. No idea when I got it, but it looked angry.

Let me pause here and remind everyone that I have advanced diabetic neuropathy. That I didn't feel this wound when I got it wasn't a surprise. The wounds that I DO notice come from collisions where deeper nerves have registered the impact.

"Rob, you promised humor in your posts. This sounds pretty serious so far." You're right. So here's a moldy oldie. Q: If a one-L lama is a priest and a two-L llama is an animal, what's a three-L lllama? A: A really big fire. (Get it? A three alarm fire? Three fire stations show up to fight the... Never mind. I heard it back in junior high. Oh, sorry, "middle school" for you kids today.)

So my friend and I notice the wound, but we were almost done with my errands, so we finished up and he got me home. Once the groceries were put away, it was time to assess my wound. 

Quick! Change tense to make it extra confusing!

1. How does it look? The surrounding skin looks red and angry, but not blazing red. Due to the discoloration of my skin from countless wounds and scarring, it's sometimes difficult to make a visual assessment. If it's visibly red, it's getting infected.
2. Does it hurt? Now that I know it's there, I concentrate. If I can sense even a small bit of pain, it means that the infection is creeping its way deeper. On the scale of 1 to 10, with 1 being no pain whatsoever, I was at a 2.
3. Is it warm to the touch?* This one requires taking a bit of care if the wound is fresh. You really don't want to stick your fingers into an open wound. During this assessment, however, it had already scabbed over, so I didn't need to be as careful. DON'T EVER PICK AT A SCAB ON YOUR LEGS AND FEET! You'd only be inviting more bacteria into the wound. This one is a little tricky for me. My wounds often don't feel any warmer than the rest of my leg. But if I elevate my leg and allow the blood to flow properly, my wounds can wind up feeling very warn indeed.
4. If there's fluid leaking from the wound, what color is it? Clear fluid, like that which comes from a blister, isn't too worrying. White pus is an indicator that it's getting more seriously infected.
5. Is there swelling? This one's tough, especially if you're an older diabetic with any degree of water retention in your legs and feet. Your clearest indicator will be if the wound itself is raised. If you can't tell, simply move on.
6. Is there a foul odor? If you can smell the wound at all, things aren't good. So...
7. Check for a fever. Most hospitals define a fever as 100.5 F (38.06 C).

Depending on severity, any one of these things can require you to drop everything and head for the nearest hospital. But for me on that day, there was nothing that made me panic. Red, mildly painful...? Meh. I contacted my PCP through the patient portal with his office and reported the wound. The next day, an antibiotic was delivered. No muss. No fuss.

For the record, regardless of the severity, if you are concerned about the state of a new or new-ish wound, call your doctor if it's daytime, or head to the ER if it's night. Better to be a bit overly cautious than under-cautious.

I basically treat all of my wounds the same in terms of dressing them. If small enough, I'll use gauze with two adhesive edges. Even if it claims to ne "non-stick," I use some antibiotic ointment to prevent a scab from sticking to the dressing, because they'll sometimes do that regardless of the claims on the box.

But sometimes these dressings can be finicky. My skin is dry and flaky, so the edges of the gauze can start to lift up. My solution - and I really should stop doing this - is to apply a little medical tape to hold it down... which is exactly what I did on Sunday. When I went to change the dressing, the tape I'd used to hold it down ripped off a chunk of skin!

Diabetic blisters. I've mentioned them a couple of times. Their cause is unknown. They just show up to become a health hazard. The blisters that I develop start off in stealth mode. The area is flat, but with a little probing I can feel the pocket of fluid underneath. Because there'd been fluid between the layers of my skin, the tape ripped off the topmost layers on Monday.

I live alone. I don't even have a pet. But that doesn't stop me from vocalizing my frustrations. Not "verbalizing." No, that would require intelligible words. Instead, I start swearing like Fred Flintstone. Basically a lot of grumbling and growling.

Great. More holes in my flesh to worry about. Diabetes mellitus really is the gift that keeps on giving.

Which brings us to this morning. Time for a fresh dressing on all of the holes. And while inspecting the area around where I'd ripped off that patch of skin, I could feel more fluid underneath. The surface hadn't bubbled like a proper blister, so how was I to know that it would burst? And burst, it did! Just a copious jet of stuff exploding and dripping down into my sock.

This. This is a spectacular day. 

Now I have two separate areas of my lower leg with gauze over them, and I was smart enough to use an old ace bandage to hold everything in place... or so I hope. The problem with using an ace to hold the gauze down is that there's nothing holding the elastic in place. Thus, it can slip up, down, or even around my lower leg.

It wasn't all that long ago that I was ignorant of diabetic blisters. I wasn't affected by them, so there was no reason for me to know they even existed. Once they started, however, they wouldn't give up. Sometimes I get a few months reprieve, but they always come back.

What's my current status? I've called my doctor's office to request "the big guns." The area where the skin came off looks dark and ugly, and it's stinging quite a bit. I don't want to play any games with it, so I asked for a stronger antibiotic.

Meanwhile, if any of you are diabetics that aren't controlling your blood sugars, know that exciting nonsense like this awaits you. Take my words to heart, not Cookie Monster's.

But we do, Cookie. We really do.

Saga of the Foot - Part 6

Y'know what I forgot? The actual cause of the ceaseless fluid leak prior to my amputation. Well, once my foot was removed, it was sent off to a pathology lab, where it was subjected to several tests, and... I'm kidding. It was immediately sent as biohazardous waste to be incinerated. While it might have been interesting to know the cause, the point was moot. The foot had to go. The foot went. End of story.

But when the doctor told me the foot had been incinerated, I did joke that I'd changed my mind and wanted it reattached.

My recovery from the surgery was prolonged by a mystery. With there being absolutely no source, a blister formed on the underside of my residual limb. The picture I'm about to show you is post op, just before the staples were removed. You'll note there are plenty of stitches that would remain for another couple of weeks.

I've circled the blister for your

viewing pleasure.

Blisters are usually the result of something constantly rubbing the site or a severe burn. We didn't know it at the time, but this was a diabetic blister. Do you know what causes diabetic blisters? No, I'm actually asking you, just as I did with diabetic neuropathy. Because no one really knows; I was hoping maybe you had the answer. They appear on the extremities for no apparent reason, so that's one more thing to be vigilant about if you're not controlling your blood sugars.

Fun, right?

After three long months of post op healing, I was finally given clearance to get fitted for my first prosthetic. Off I went to the orthotics lab, where I was given... a limb shrinker! I wish I had a picture of the one I used, but I never took one. Don't fret, though, because I looked up a generic one for you!

One limb shrinker

shrinking a limb.

Maintenance of one's residual limb is important. Even after all the incisions from surgery have healed, there's going to be significant swelling. Despite the fact that your eyes can see it and your conscious mind acknowledges it, your body doesn't know that your foot is gone. It needs to be retrained to recognize that it doesn't need all of that extra blood, oxygen, and nutrients. And what better way to retrain it than with some Lycra to strangle your flesh?

For the first couple of weeks, I faithfully wore my limb shrinker day and night. Then I got annoyed. I wasn't sleeping through the night because I'd bend what was left of my leg in my sleep, causing the Lycra to bunch up at the knee, and it would pinch my skin painfully. In all honesty, I have enough reasons to be taking powerful painkillers. I was NOT going to add irritation from a leg shrinker to the list.

On my next visit to the prosthetist, I told him that I was wearing the shrinker for most of the day, but that there'd be no convincing me to wear it at night. Because of my stubbornness, my residual limb might not be small today, but I'm not overly concerned about that. When I get to remove a source of pain from my ever-growing list, I'm a happier camper.

A mold was made of my stump and I returned two weeks later for my first official fitting. This was it. I was getting my first new leg! Adjustments to the socket and the angle of the foot were made, and then, for the first time in six months, I WALKED! I was a little stiff and shaky at first, but the prosthetist was impressed at how quickly I was able to start taking regular steps. He said that 80% of new amputees tend to simply forget how to walk. Obviously, I hadn't. Although... After my first few hesitant steps, I stopped and did an imitation of Peter Boyle from Young Frankenstein, shouting the strangled line, "PUHHIN ON DA REEEZ!" (Movie trivia: No one was sure what the creature should say, so Peter Boyle improvised the line and comedy history was made!) The prosthetist thought it was hysterical.

My first month with my new leg was a pain in the tuchas. It was a struggle every day to get the pin on the leg cover to line up with the hole at the bottom of the socket.

The prosthetic as a whole.

The notched pin. It is NOT a screw.

The hole at the bottom of the socket.

Can you see why it might be a problem at first? Once the leg cover with the pin on the end was inside the socket, I could no longer see my target. Putting it on each day was a 5 to 10 minute ordeal. I commented once that I wished the socket was transparent, but the prosthetist said that they couldn't make the carbon fiber socket see-through.

Fiber. Carbon. Socket. You have no idea how much abuse this thing can take. Obviously you shouldn't try to damage your prosthetic, but someone experimented. She explains that it's the epoxy that eventually burns, not the carbon fiber. 

Aside from the obvious reason of why you shouldn't try to damage your detachable leg, since you kind of need it to walk, is the price. Gods above and below, THE PRICE! Being on Medicare, I get a lot of mail that starts off with, "This is not a bill." It's Medicare's friendly way of saying, "If you didn't have us, this is what your medical expenses would look like." Well, I got one of those for my leg, and the amount covered was about $5 shy of $8,000.00!!! I could have gotten a prosthetic CAR for less! For that kind of money, it should come with all sorts of James Bond-like extras. Like I could press a button and little wheels would pop out of the foot, and then I could just push along with my good foot. Or maybe a small refrigerated space to keep a cold drink. Or maybe a gun that comes out Robocop style. SOMETHING! Instead, all I get is next-to-impossible-to-destroy carbon fiber, advanced, lightweight alloys, and a foot engineered to simulate the natural gait of walking.

Jerks.

Having seen the price tag of my new leg, I went online to find out what the "black market price" was for it. Maybe I could sell my leg for a profit, tell insurance that someone stole my leg, and they'd get me a brand new one. Financial windfall, here I come! 

Follow me for more tips on how to defraud the government and wind up in jail!

The problem is that my prosthetic leg is worth $8,000 to me and ONLY me. Online, if you want a used prosthetic leg, you can get it for around $150 at the most. It won't fit anyone but the original owner, and it's alignment will only benefit them. In other words, a used prosthetic leg is worthless.

There was one other aspect of being an amputee that required an adjustment of conscious thought: socks. These are layers of Lycra that can be added to the leg covering to improve the socket's fit to your leg. There are all sorts of reasons why your residual limb might change size. Leg elevation, water retention, continued use of a limb shrinker. Gaps that form between the leg cover and the socket can cause pain, sores, and even calluses. To prevent these, "socks" can be slipped over the end of the leg cover. They come as one-ply, three-ply, and five-ply. If you're not catching on, think two-ply toilet paper. It's the thickness of the socks.

Seen here: one five-ply and one three-ply

sock on the end of my leg covering.

Here's the issue: I have to make sure the pin comes through the end of the sock. If I don't and force the pin into the socket, it gets jammed in place. Until I figure out a way to get it off, I'm then stuck with the leg attached. I had a couple of minor jams and one MAJOR. The major one required my to get into the shower and force soapy water into the leg covering so it would get slick enough inside to slip off me. Then someone whose hands haven't been decimated by diabetic neuropathy had to come help force the pin to release the sock-covered pin.

Fun times.

Well, quiet people, we're very near to the end of this saga. All I need to tell you now is the epilogue. About the massive lawsuit I brought against the doctors who didn't listen to my pleas for help when I made them, and their comeuppance for being the primary cause of the loss of my foot. More than the physical damage, there was the immeasurable psychological trauma of having a foot I'd lived with for over 51 years amputated. It's a light at the end of this nightmarish tunnel, right? See you next post!