The Grand CGM Adventure

It's been a hot second, hasn't it? I essentially ran out of things to discuss. I'm not a doctor, so I'm not going to come rushing back here "With the latest news in diabetes treatments and technologies!" But it's once again time to check in because something old and new is happening.

Go ahead, Rob. Confuse what few readers you have.

I'll start with the old stuff, which involves my diabetic neuropathy. This is some BAD juju. My nervous system is in such rough shape that I can no longer accurately tell what my blood sugar is without a meter. It wasn't as though I could guess a number and have the glucometer confirm it, but I could at least say when I felt high, low, or normal. Now...? I'll feel hyperglycemic when I'm actually normal. I'll feel hypoglycemic when I'm running a bit high. And apparently I've gone as low as 54 without feeling it.

That, my friends, is a dangerous way to live.

For several years, I've griped about how Medicare doesn't cover CGM's. Continuous Glucose Monitors. It was so stupid. Here was a piece of technology that could help us diabetics know at a glance what our blood sugars are before, during, and after meals, which could lead to tighter control, and they refused to pay for it...

...until March of 2022. I found this out when I'd finally lost my patience with not knowing what my blood sugar was doing. This is when my glucometer came back with a reading of 54, and until I saw the number, I had no idea I was that low!

Part of my problem with monitoring my sugars was the fact that the prescription for my testing supplies read that I should check "four times daily." That meant, at the most, I could only check four times a day because insurance wouldn't allow for extra tests. I was determined to send a message to my PCP through the patient portal saying that I needed a new prescription that would allow for testing up to eight times a day.

While typing out my message, I got curious. Off to Google I went to ask, "Does Medicare cover CGM's?" I felt I already knew the answer. "No. Beg all you want, peasant! We only pay for technologies that are around five steps behind anything people would consider 'modern'." So imagine my shock when I discovered that CGM's have been covered since March of 2022!

If I had two feet, I'd have danced a jig!

My message to my PCP was changed to "I need a CGM yesterday!" He agreed. And while he and my pharmacy were jumping through bureaucratic hoops, I learned that I would still need the supplies to test manually eight times a day, just to make sure the CGM was working properly. I would swiftly learn it's just a wee bit more complicated than that.

So now that I have a CGM stuck to me, here's how testing goes:

1. Check the CGM. Let's imagine it says that my blood sugar is 133.
2. Manually check my glucose. The meter say I'm 92. 
3. That's a fairly sizeable gap between results, so I go into the receiver of the CGM and calibrate it to the meter's results.
4. Finally, I get another read from the CGM and it now reads 103, which is a much better differential, 92 to 103, than 92 to 133.

The thing to keep in mind is that BOTH devices aren't 100% accurate. There's always a miniscule +/- variable that we mere mortals can't calculate. We have to operate on the assumption that the meter is closer to the right number, and therefore we need to "teach" the CGM to close the gap when it reads a wide difference between results.

Now for some confusion... because what would my life be without confusion, right?

I kind of cheated when I sat down to learn how to use my sparkly new CGM. I went to YouTube, found the manufacturer's channel, and watched a few "how to" videos. The video on calibration said to calibrate the receiver every 12 hours. That seemed... wrong. If it was going to have such a wide discrepancy every time I manually checked my glucose, shouldn't I calibrate at that time?

It's my philosophy that "smart technologies" are very smart at all. Do the wrong thing at the wrong time and you could confuse whatever device it is that's supposedly "smart." Without insurance, my CGM costs over $550 for three sensors, one transmitter, and one receiver, so I was afraid I'd break something and wind up having to scrounge up the money to replace it... which is why I called up their customer service line to ask if I calibrated every time I checked my glucose manually, would it... ummm... blow up?!

The simple answer? No. In fact, the CGM seems to be more accurate every time I calibrate it. After four days of correcting the receiver, there's been less and less of a gap.

Going from most recent to most distant, my last four A1c's have been 6.8, 6.5, 6.5, and 6.4. My PCP is starting to think I'm a unicorn, in that he's simply not accustomed to seeing a diabetic consistently stay between 6.0 and 7.0. Why bring those up? Because if I followed how I felt without knowing what my blood sugar actually IS, my A1c's would turn to garbage. Allow me to give an example:

Sitting here, watching a movie or writing a thing, and suddenly I'll think I'm feeling low. That's when I'd reach for something to bring my blood sugar up. I wasn't allowed to check my glucose between meals due to insurance restrictions, so I'd blindly treat what I believe is hypoglycemia. Yesterday, I started feeling low, but now I had the benefit of pressing a button on my CGM receiver, and... Hmmm... It says my glucose is 144. Is that right? Check manually, since now I can check eight times a day. My meter says I'm at 130. I would have eaten something to raise my blood sugar when it it was completely unnecessary! If I did that too often, my A1c would come back indicating that I was losing control of my diabetes.

Also, do you remember my entries that included the Somogyi Effect? Well, now the CGM's alarm sounds when my blood sugar dips in the middle of the night. Unfortunately, the device isn't as fast as I'd like it, so its alarm will go off repeatedly while I'm treating my hypoglycemia. I wish there was a way to teach it patience. Like, "Dude, cool pits. I'm working on it. How about you learn how to alert me when my sugar's reaching a normal level?" Alas, I fear I'm asking too much.

So, my friends, we've reached the conclusion of this latest adventure. This is usually the part where I put a picture of a beautiful woman and claim that she's my wife. Alas, todays human female is FAR TOO YOUNG. Take a look...

This is Faye Nightly, age 10.

For reasons beyond my understanding, my Facebook feed will throw suggestions at me, trying to catch my interest. Their suggestions are usually WAY off. Then one fine day, FB suggested little Faye, here. What captured my attention immediately was her massive wealth of hair! There's just so much of it! It's crazy! As I understand it, her hair has never been cut. Trimmed, perhaps, but never outright cut. So she's been growing that mane since birth! She's youngest and smallest of some youth acting/dancing troupe. (Apparently she's 10 years old and about 4' 6".) She has an Instagram account if you want to learn more about her. Just don't be weird about it, okay?

Still, I can't end my post with stuff about a little girl with enough hair to play Medusa in the MCU. How about bringing back a classic?

It's the return of Jane Douglas!

Hey, I sent her the divorce papers! "Jane Douglas, Somewhere in the U.K., possibly near London." Since she hasn't sent them back, I'm assuming she wants to remain married to the walking, talking wreckage that is me. If she wants out, she can send me her exact address. 😁

Calling in Sick to a Doctor's Appointment

Does that sound absurd? It should, because it is. And I've done it. Multiple times.

Like today. I wrote about the Somogyi Effect and how I thought I had a handle on it. Yeah, not so much. The good fasting blood sugars are rarer than the ones that are utter garbage. This morning, I woke with a glucose of 403. FOUR HUNDRED AND THREE! You must be thinking, "What on Earth did you eat last night, Rob? An entire chocolate cake?!?" No, my evening snack was a couple of microwave chimichangas, a total of four carbs on a diabetic exchange diet. (Not to be confused with 4 grams of carbs.) My glucose at the time was 126, so I took only enough insulin to cover the meal. My thinking was that if I tried to add just a little more insulin to bring my glucose closer to an idyllic 100 that I'd be risking the slingshot effect of a Somogyi. For all of my careful thinking, I got a fasting glucose of 403.

I had - past tense - a podiatry appointment this morning. I'd just seen my podiatrist nearly two weeks ago, but was still experiencing a bit of pain. When you have advanced Diabetic Neuropathy, a "bit of pain" could be an indicator that something is very wrong. Mind you, the pain has diminished since I called to make the appointment, but I was still going to get it checked out. Better safer than sorrier.

The problem is that I can't go to a doctor's appointment when my blood sugar is so high. I need to monitor it. Take extra insulin if necessary. Be around food in case I overcompensate with my dosing. If I had a Continuous Glucose Monitor (or CGM), this would be less of a concern, as I'd know what my glucose was doing with the application of an app on my phone. But Medicare doesn't cover CGM's. As a result, I called in sick to a doctor's appointment.

The greatest culprit when it comes to missing medical appointments has been my Diabetic Neuropathy. The burning sensation in my skin would make it impossible to wear clothing, since contact with even the softest material would make me want to cry. This wouldn't be a problem if I could just go where I needed to go without a stitch of clothing on, but not only are there laws against that, but no one - and I mean NO ONE! - wants to see me naked.

I sincerely wish people would leave comments to let me know if these lessons and stories are getting through to them. I see some people are reading these meandering musings of mine, but I have no idea what effect I'm having. And no one who's read my last entry has donated to my GoFundMe. (Please, if you can't give, share the link. The sooner I meet that goal, the sooner I can stop worrying about this.)

Anyway, we're nearing the end of my post and I haven't posted a picture of my new wife.

Look at those dimples. LOOK AT THEM!

That, my friends, is English actress Jenna Coleman. As I did when "married" to Jane Douglas, I sent divorce papers to Jenna so that she might escape her relationship with me. It's only fair, right? Alas, an address of "Somewhere in England" probably won't reach her, so she and I will remain a wedded couple... until some other beauty catches my eye and I declare that one my bride. What can I say? I'm capricious.

Until my next post, whenever that may be.

That's a Mouthful

If you go waaaaay back to November of 2022, you'll see a post, "Dentist!" It was quite the experience, and I decided I'd had enough of these oral adventures. It was time to see the dentist regularly. I could at least bite things with my front teeth and chew on the right side of my mouth; I should try to keep the teeth that remained. Thus, after that agonizing visit, I scheduled a cleaning.

But in case you haven't been paying attention to my stories, "Life is what happens while you're busy making other plans." That John Lennon quote fit my "cleaning" visit to a tee. Y'see, there's been quite the build-up of calculus around my front teeth. Yes, calculus. "It's not just math!" Calculus is hardened deposits of plaque.

Okay, let's back up. When my left foot was amputated, I went six months without taking even minimal care of my teeth. I was so overwhelmed by my struggle with all of the other forms of bodily maintenance that my teeth were ignored. That's when the plaque started building up. Once it had a foothold... (A foothold in my mouth? Weird.) Once it had a foothold, the plaque continued to build-up, even when I started brushing regularly again.

Following so far? Good. Because now we have to add other complications to the scenario.

1. Receding gums runs in my family. My brother was wearing partials in his early 40's, and both of my parents had full dentures by age 50.
2. The medications I take can dry out one's mouth. I'm constantly drinking something throughout the day. Even when I wake in the middle of the night, the first thing I do is reach for the drink I have at my bedside. Dry Mouth: It's a lifestyle all its own.
3. Diabetes. Diabetes, diabetes, diabetes. It was mentioned at least FOUR times during this "cleaning" visit. Without ever specifying what it was about diabetes that added to my problems, it was made clear that 48.5 years of this gold-star chronic illness had contributed to the poor condition of my mouth.

I didn't need a professional to see the rather extreme situation in my front teeth. My gums had been pushed way down, with a lot of calculus at the base of the teeth. Even with that hardened substance's presence, my teeth could be wiggled with just a gentle nudge. Which led me to ask, "If you clean away the calculus, will my teeth just fall out?"

Y'know, it's a little sad when the dental assistant working with you gets excited that YOU reached a conclusion before they could mention it. The dentist was proud, too. And the answer was, "Yes." I asked if they could at least clear away the calculus that would lead to painful gingivitis, and they said my teeth would likely fall out if they did that little bit.

So what? It's a tooth. If it looks like the plan is going to be a complete removal of all teeth, what's the big deal if some fall out?

Oh, nothing special. Just an increased risk of infection because - you guessed it - diabetes.

By the way, that was the plan we discussed. My gums had seriously receded, even where there was no calculus. All but two of my teeth moved when nudged. Things can get caught in teeth that are as loose as mine. Those things can lead to infection, and often do. I have to lose the teeth. All of them.

This news coming on the heels of the EMG results has knocked me flat mentally. Well, not just this, because Dunder Klutz here stumbled after a shower, and my foot smashed into the rather sharp corner of a shelving unit in my apartment. To be specific, it was the inside of my foot, where a particularly large callus resides. Well, resided - past tense. I didn't think much of that collision... until I spotted the blood stains in my carpet. Seems that after my shower had softened that callus, the impact sheered it off, leaving me with a bloody mess of a wound.

So... Very little muscle left in my hands... Serious wound on my foot that I didn't feel, thanks to diabetic neuropathy... I have to lose all of my teeth... Yeah, I'm feeling the weight of existence more than usual. What's more, I'm going to need dentures and I can't afford them. So what if I'm a diabetic that needs to eat? I could live on mashed potatoes and peanut butter, right? I'm going to have to beg and plead with friends to help me get prosthetic choppers, since Medicare doesn't offer dental insurance. 

~as sarcastically as possible~ Life is just grand.

Let's change the subject entirely. Remember when I advertised the scantily clad young woman? Well, this isn't her:

Say hi to Keet!

This gorgeous young woman is Rachel, or Keet, as she often says very quickly at the start of her videos. I think she's only 17 at the moment, but I could be wrong. She has a rather serious case of Tourette's Syndrome. Her tics can be quite entertaining because her voice pitches up when she experiences echolalia. She sounds adorable! But she's suffering. She has no control over the sudden movements or outbursts. She posted a video that was only a small portion of a four-hour tic attack. If you want to follow her, then I'll link to her TikTok. But behave. She's underage. She's been bullied. She's been accused of faking. She'll continue to experience these things from a variety of jerks for the rest of her life. Don't be a part of that. Listen to what she has to say and bask in her beauty. Don't be mean or creepy.

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.

A Word of Warning

Most of my last few posts have been about me. Disappointing, isn't it? But then I can't write about you, since... Well, I'm not you.

I know. I'm brilliant like that.

There's an underlying cautionary tale in these posts about me dealing with one crisis after another. If you don't control your diabetes, you could be living a very similar lifestyle. This is different from me telling you about one specific problem in a post. This is the various complications attacking simultaneously. It's a diabetic blister that's followed by your dry, delicate skin tearing when you remove the wound dressing. While your coping with those wounds, even more appear because you unknowingly collide with a whole host of things with your lower legs. The reason you don't know it is because diabetic neuropathy has wrecked your nervous system. 

But why stop with a few open wounds on your lower legs when you can add a dental infection. It wasn't anything so dramatic at first. Just a bit of receding gums from constantly battling dehydration during hyperglycemia, and then the tiniest particle of food gets caught between one of your teeth and your gums. You somehow didn't feel it, and despite brushing your teeth regularly, you ended up with a little invader that thrives in the bacteria-rich environment of your mouth.

Now that you have several trouble spots that can become serious infections, your body goes bananas in its effort to fight. Reserves of sugar and naturally occurring steroids send your glucose skyrocketing, making it even harder to control.

And then, sneaking in under your radar, is something you're completely unaware of. All you did was take some ibuprofen to deal with the pain in your gums. Ibuprofen is an NSAID - Non-Steroidal Anti-Inflammatory Drug. Since your gums were swollen, taking an NSAID seemed like a smart thing to do. Heck, your doctor approved its use!

"So what, Rob? Ibuprofen - AKA Motrin - is an over-the-counter drug. It's no big deal, right?"

Under most circumstances, I'd agree immediately. But there's this little complication for diabetes known as Diabetic Nephropathy - AKA Diabetic Kidney Disease. Like just about every other complication, it boils down to high blood sugars altering the shape and functionality of microvascular vessels. 

Forgive my lack of proper structure, but I'm switching from what could happen to you to what's currently happening to me.

I've been lucky. Only once did I start showing signs of kidney failure in my lab work. But the next time I was tested for it, whatever damage that was supposedly happening was no longer apparent. So precautionary measures were taken. I was put on a very low dose of a drug commonly used to control blood pressure and protect against kidney damage.

Amidst my battle with gingivitis, I was a bit too distracted by the pain to really pay attention to it... but as the pain lessened, I noticed that my right leg was swollen. VERY swollen. Obviously it's water retention, but it's EXTREMELY sudden.

At this stage, while waiting for my PCP to get back to me, I'm going to make an educated guess. I could be completely wrong. Heck, I hope I am! But I could also be right, and that scares me silly.

Brace yourself. It's time for another list.

1. I can't take doses of ibuprofen higher than 400 mg. (Maximum strength is 800 mg.) Exceeding 400 mg. per dose makes my kidneys ache. Why? Because...
2. Ibuprofen can cause nephrotoxicity - poisoning of the kidneys. This isn't to say that this is a common risk, but people with existing kidney disease and heart disease should definitely consult their doctor.
3. About a year ago, a lab test came back with a cautionary flag. There was a trace of hematuria - blood in the urine not visible to the naked eye. This is NOT what they look for when testing for diabetic nephropathy, but in my semi-panicked brain, it could be a sign something was off. (They typically look for albumin, a blood protein your kidneys should not be filtering out.)
4. During my gingivitis adventure, I was taking 400 mg. of ibuprofen every eight hours. Regardless of the dose size, it would be taken every eight hours at the most. This, however, was more ibuprofen than I'd taken in a LONG time.

So, ummm... Did I damage my kidneys with an OTC during a completely different crisis?

Okay, let's all stop and take a deep breath. It's important to remember that I'M STILL NOT A DOCTOR! I'm fully capable of making myself paranoid, especially when "doing my own research on the internet." In fact, I'm sure if I dug deep enough, I could have myself diagnosed with "leg cancer" by the end of the day. This is why I'm constantly telling you to consult your doctor. I can only offer up so much information before I reach the limit of my knowledge.

As is my habit, it's time to add pictures to my post. I'm afraid I don't have a beautiful woman or silly joke this time around. No, what I have are a couple of pictures of the swelling in my leg.

Oy vey 1.

Oy Vey 2.

Maybe you can see it, maybe you can't. My leg is significantly larger until it reaches the discolored portion, where the swelling suddenly stops. And in the second picture, you get to see the scab of yet another leg wound.

The good news...? The site of the diabetic blister has healed up nicely, hasn't it?

Okay, readers. I'm off to stew in my paranoia and await word from my PCP. I'm more than likely going to need a lab workup to determine what's ACTUALLY happening. I'm also going to mourn my carb-free snacks, as the reason I was able to get away with them was my lack of water retention. "Alas, poor Pork Rinds. I knew them, Horatio. A snack of infinite yumminess." 🙁

EDIT: My PCP has gotten back to me. He agreed that NSAIDs can cause kidney troubles, and told me to stop using the ibuprofen, (which I already did), and cut down my salt content, (which I already did). If I don't see improvement soon, he'll order labs. Personally, I'd prefer he order them now, but as stated earlier, I'm not a doctor.

Posting Schedule Derailed

My posts are going to be erratic for quite some time. I'll still be posting, despite the deafening silence of the minute masses, but a serious problem has arisen.

In my 8 September 2022 post, "My Poor Beleaguered Psyche," I mentioned the possibility that I was developing carpal tunnel syndrome - CTS - and how diabetes can be a causal factor. It hasn't been officially diagnosed yet, but a new symptom has been added to the mix.

Calm down. I know it's exciting to watch me slowly fall apart, but control yourselves, you savages.

Yesterday, without the slightest provocation, the pad of my right thumb started to hurt. It wasn't a pain that slowly developed. It went from 0 to 60 instantly. (I know the pain scale is 1 to 10. I wasn't using that. I was using... ~ grumble-grumble-grumble ~ Never mind.) I took 1,000 mg. of acetaminophen, 400 mg. of ibuprofen, 5 mg. of oxycodone, and wrapped my thumb with a trimmed down lidocaine patch. I got some relief, but not a lot.

Some of my pains... If I ignore them overnight, I wake up and they don't bother me anymore. I chalk such things up to my nervous system having been ravaged by diabetic neuropathy and leave it at that. But this thumb pain was just as intense this morning, so I committed the cardinal sin of "doing my own research."

It's cancer. It's always cancer when you look things up on your own. Obviously, I have thumb cancer. "Thumb cancer" isn't real, but now I have it. Fite me! 😛

In review, I have an intense tingling throughout my right hand that never abates. It will vary in intensity, but it's always there. Now there's this incredible pain in my thumb, so I looked up "pad of thumb pain" on Google. In all honesty, I expected to get no results. No one in the world experiences intense pain in just the pad of their thumb. That weird symptom is reserved for me and my miserable luck. But to my surprise, it's a specific symptom of arthritis or CTS. Combining my two symptoms, I'm gonna say it's a good guess that I have the latter.

So I'm not a happy camper, and I'm going to have to slow down my posts a but to give my poor hand a break. I'm going to aim for every four or five days. I know this is heartbreaking for you, so let's not dwell on it.

Instead, let us celebrate this day, 22 September 2022, the First Day of Fall!

Mmm... Yummy brake pads! 💖

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.

More Than a Pain in the Butt

Wasn't the story about the loss of my foot fun? It's the kind of story that you can tell at dinner gatherings, showing off pictures that I provided and everything. Trust me. There's nothing quite like bringing up meal-destroying material during family get-togethers. If they argue politics, you can bring it to a stop with pics of diabetic feet in varying states of distress. You don't even have to use my blog. Just let Google ruin the appetites of those you despise. 

I think it's time I concentrated on something I brought up during The Saga of the Foot. Pain management. If you don't control your diabetes, you're going to experience a measure of diabetic neuropathy at some point. Personally, I have some bonus pains. The osteomyelitis in the third metatarsal of my right foot that healed a bit goofy is aching as I type this. The Charcot foot also provides some interesting pains in the collapsed arches. And as a bonus, I once put on weight so swiftly you'd think I'd gotten pregnant, which would be a neat trick for someone without any female parts. That excess weight - concentrated in the trunk of my body - puts crushing weight on my lower spine, which has become arthritic, as well as showing signs of degenerative disc disease. 

The practice of medicine is constantly changing. What was once thought of as perfectly normal treatment is viewed with a frown or worse later on. Once upon a time, cocaine was an over-the-counter item at your local pharmacy. Go ahead and try asking where it's shelved now. I'll wait.

So the old view of pain management: give the patient the amount of painkiller that's appropriate for their level of pain. Tell them they can take that dose so many times a day and to call for a refill when they run out. The baseline of this tended to be 120 tablets of a narcotic that's taken every six hours as needed. For me, this was Percocet. It's a mix of oxycodone and acetaminophen.

But my doctor between 2006 to 2010 did BETTER! He prescribed a baseline painkiller to go with the short-acting stuff. MS Contin. That's Morphine Sulfate Continuous release. 

You already know this story, right? When you take narcotic painkillers like clockwork, you develop a tolerance to them. To counter this, the doctor increases the doses. My dosing when I started: Percocet - 5/650 - that's 5 mg. of oxycodone and 650 mg. of acetaminophen - every six hours and 15 mg. MS Contin every eight hours. Within 10 years, I moved up to taking straight oxycodone, 60 mg. four times a day and 75 mg. of MS Contin three times a day. 

When people heard these doses, they stood in wonder at the fact that I was conscious and at all functional.

There's one other medication that was mixed in there that I have some complicated thoughts on. When I first started taking it back in the mid-90's, it was called Ultram. Today it's known more commonly by its generic name, tramadol. It was labelled a synthetic opioid from the start, but wasn't classified as a controlled substance until 2 July 2014. Tramadol has been the only medication that effectively addresses my diabetic neuropathy without side effects. My understanding of it was that your body didn't develop a tolerance to it the way it would common opioids. When I started taking this medication during my very first symptoms of neuropathy, I would take up to 100 mg. four times a day. That's because I wasn't controlling my blood sugars, so my pain was continuous and intense. (That dose has dropped since then.)

For me, if my tramadol doses were suspended for whatever reason, it meant nothing to me. I didn't suffer withdrawals. Not even a little bit. All I'd ever feel was an increase in my neuropathy pain.

But others... If they had a history of opioid addiction, tramadol was a trigger for them. I saw this first hand with a roommate I had. He was prescribed 50 mg. three times a day as needed for pain from fibromyalgia, a different neurological disorder that causes pain. The problem was that there was once a point in his life when it was entirely possible 80% of his body was made of opium. Like anyone with an addiction, he would go through his 30-day tramadol supply in less than 30 days. He would then have to wait for his doctor to refill it, and his doctor was in absolutely no rush to do so. In that time, he would suffer withdrawals, along with the pain the medication was supposed to address.

I thought he was insane. Tramadol isn't addictive. That's what I thought. anyway. As I've said several times before, every patient is different. So I guess it really was a trigger for opioid addicts.

There are other medications beyond controlled substances to control pain. Like Neurontin, also known as gabapentin. It's an anti-seizure drug that has a few off-label uses, like pain management and as a mood stabilizer. And boy, do I have a story about this one!

I was in the hospital for depression. Yes, your charming host and narrator had attempted to - What's the phrase all the kids are using these days? - unalive himself. I was successful and have been writing this blog from beyond the grave. (Okay, maybe not. Would have made this blog a lot more interesting, though, wouldn't it? 😁) My doctors - all psychiatrists - knew that gabapentin was used to control neuropathy pain. I was already taking 300 mg. three times a day, but I was still experiencing pain. To address this, they doubled my dose.

This is where things started going wrong for me. I became absolutely RAVENOUS! I wasn't just eating what was on my meal trays, but also whatever other patients didn't want from their trays. I couldn't control my hunger, and it wasn't really sated by eating. That's when I started gaining weight. 

I was told by one of the med nurses that gabapentin can hit with a double-whammy on the side effects front. Not only can it increase hunger, but slow down metabolism. That's what seemed to be happening to me.

By the time I'd tacked on 20 extra pounds, I explained to the nurses that controlled the ward that I needed to be seen by a neurologist or pain specialist. They said they'd call for one, and I waited. A week later, having packed on some more weight, I told them that I REALLY needed a doctor to come and address my problem with gabapentin. They said they'd call again, and I waited again. Another week went by, and by the end of it I'd gained an extra 30 pounds in about 30 days.

Remember when I brought up The Patient's Bill of Rights? Well, I could easily refuse to take the gabapentin, but I wasn't being treated with tramadol at the time, so I would have suffered a lot of pain. Besides, that would take a few days to become a problem. I needed a faster solution.

As the med nurse was making his rounds the next morning, he handed me my insulin syringe... and I handed it back. "No thanks," I said, remaining neutral to what was obviously not going to go over well in a psych ward! When asked why I would refuse my life-sustaining medication, I replied, "Well, I've insisted that I need a doctor to address my neuropathy pain. It's two weeks since my first request and no one's shown up. Since it's my right to refuse medications, I'll skip the insulin and more than likely become incredibly sick. That's when I'll be moved to a medical ward, and then some will HAVE TO come see me."

As insane as the idea seemed on its surface, it made a lot of sense. And by keeping my cool, I came across as perfectly rational. The head nurse eventually came to discuss the situation. He ASKED that I take my morning dose and he would personally call for a neurologist or pain specialist. I agreed, but warned that my lunch dose wouldn't be taken if no one showed up.

Two hours later, I was discussing treatment options with a pain specialist. This was the doctor who took a liking to my phrase "pain seizures." What can I say? I have a way with words and word-like substances. 😉

Because of where I'm currently located, finding proper pain management has been difficult. I'm actually scheduled to see a new pain doc in two weeks, so we'll see how that pans out. I came away from the last one determined to never see him again, despite him saying he was willing to treat me. (Maybe I should cover good and bad doctors soon?)

Meanwhile, my PCP has been handling my pain. It becomes somewhat difficult to do that with me because something on me is always breaking. This will sound insane, but just after I started seeing him, I sneezed so hard that I separated a rib from my sternum. It even has a name, costochondral separation. And this was the second time this had happened to me! Every breath was absolute agony.

So what can I say in summation to all of this? I mean, you're going to experience some intense pain if you're not controlling your diabetes. When and if that happens, what should you do?

1. Talk openly and honestly with your doctor. I've said as much before, but it warrants repeating. If you're not communicating with your doctor, you're in for a world of trouble. Improper treatments and medications can make things much, much worse.
2. Always, ALWAYS, ALWAYS, ALWAYS, ALWAYS discuss other options before turning to narcotics. There are other medications that can work depending on the severity of your pain. 
3. See recommended specialists. As the complications of diabetes accumulate, the list of doctors you'll need to see is going to get annoying at the very least. But you have to see them because they're specialists. They focus on just one aspect of medicine. They'll know about the latest treatments available to you.
4. Do not seek out narcotics first! Once you open that can of worms, you're in for a lot of needless drama. My fight to get off those absurdly high doses of opioids was one of the most difficult things I could do while simply sitting around. I was not addicted to them, but my body had become dependent on those high doses. (Where I exhibited addiction behavior was with cigarettes, which is a different story.) Overall, it was a pain to reduce my painkillers.
5. Take medications AS PRESCRIBED! Whatever the medication is, don't get creative. A common misconception is that "more equals faster." It does not. Not ever. Never forget that accidental overdoses are a thing that has claimed countless lives. (See numerous celebrity deaths for reference.)

That's all I have for today, folks. But you know what might be fun...? Putting up an unedited post. One that includes my every spelling and grammatical error. I don't know if I could pull that off. All of those little red lines beneath my mistakes would drive me up a wall!

And now... Place your bets! Can Rob get the picture of the beautiful, scantily clad young woman this time? You know he can't, but he'll keep trying. Let's see what today's photographic error is!

Well, we got close. It's her knee.

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 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!

Saga of the Foot - Part 5

Well, my commentless readers, this is it. The part where... I yell at you some more for remaining silent! Blogspot's analytics say SOMEONE is reading my posts, but no matter how many times I ask, no one comments. I'd like to know if I'm doing well or poorly.

Why, yes... As a matter of fact I AM rather needy. (Send hugs.)

That out of the way, we've reached the part where I lose a few pounds in just one hour. In terms of a weight loss program, I do not recommend amputation.

The first step was a visit to my Primary Care Physician - PCP - to be cleared for surgery. Between September 2011 and October 2018, I had 15 different surgeries, most of which were on my feet. (The vitrectomy and cataracts surgeries are in there somewhere.) Thus, having my PCP look under the hood, check the oil, and kick the tires was old hat by now.

It was as I was leaving his office that this very real exchange occurred. I love telling this story because it sets the tone of my public attitude about what happened to me. The nurse - a sweet, empathetic woman - was somewhat melancholy as I was leaving. "Well," she began, "I guess we'll see you... after."

To which I replied with an oddly cheery voice, "Yup. Next time you see me, I'll be a foot shorter."

She lost it, nearly coming to tears with laughter. Some people, however, are reluctant to laugh. They know I'm joking, but don't want to laugh at my loss. If I didn't want people to laugh, I wouldn't tell the story. And in case you're wondering, this is 100% true.

The basics of my BKA - Below the Knee Amputation - were simple enough. I'd be knocked out. They'd do a nerve block for my lower leg. They'd cut and cauterize what they needed to. Post op, I'd have to wear a brace for two weeks to prevent contracture. Contracture is when the muscles and tendons permanently tighten, causing a serious decrease in range of motion. If that happened, learning to walk again with a prosthetic would have been next to impossible.

I'm going to show you the brace, but the picture requires an explanation. You see, the best investment I've ever made in my entire life was the $1.07 I spent on a bamboo back scratcher at a dollar store. This thing's been a life-saver! Knowing I was going to be hospitalized for a while, I made sure to pack it with my other belongings. Combine the back scratcher with the brace and we wound up with the following picture and caption:

"Rob has already fallen victim to Medicare

cuts. His prosthesis is less than adequate."

Oh... That thing strapped higher up on the brace was to prevent it from chafing my other leg. Velcro somehow manages to make life easier and more difficult simultaneously.

The two weeks after the surgery are kind of blurred. I was, after all, on copious amounts of painkillers. But here are some of the highlights.

1. I learned a thing about amputations, or at least the style that I got. (Different situations require different procedures.) When they removed my foot, they cut my Achilles tendon, and then rolled it and the muscle up, "tacking" it in place on my severed bone. Mind you, I never asked what "tacking" entailed; for all I know, the doctor used a thumb tack to hold it in place.
2. I had two and a half to three hours of physical therapy a day. Every time I was told that if I performed one activity or another for so much time or covered a certain distance, I would score higher on my final evaluation. I took those as challenges. Looking back, I wish I'd done worse, but more on that later.
3. The young physical therapist that was nearly half my age and that I thought was absurdly pretty just had to be the one to assist me in taking my first post op shower. And wouldn't you know it, while waterproofing my residual limb with medical tape and plastic bags, I just had to discover how soft her hands were on my inner thigh! I think that may have been the very first and only time I was thankful for having E.D.
4. Making sure I could get off the floor if I took a fall. I initiated this exercise because I was aware of how alone I'd be at times. A fall was inevitable. Of course, I was lowered to the floor for this exercise. Knocking me over or letting me fall was apparently against hospital policy.
5. Being compared to the late Don Rickles. (Frank's story at the end of that clip is the best!) I feigned a lot of irritation over things that were beyond anyone's control, with reactions so over-the-top that it would get others laughing. I actually found the comparison flattering.
6. Because my amputation occurred right around Halloween, I suggested someone get me a stuffed toy shark so we could tear open its mouth and fit it around the end of my now-incomplete leg. 😁 Toy sharks of the appropriate size weren't available at the time. 
7. The first people to stare at me.

That last one was mostly amusing to myself. I was left at a hospital exit while someone brought a vehicle around to assess if I could get in and out of it. While I was waiting, a mother and her two kids came in. Without even realizing it, all three of them stared at me. With as much excitement as I could muster, I gasped and said, "My first starers!"

Confused, the mother asked, "What?"

I quite happily explained, "You're the first people to stare at me and my loss of limb! Big day for me!" She was immediately apologetic, which I cut off swiftly. "Please... If I was upset, I would have snapped at you and the kids. I'm trying to make light of it so my circumstances don't drive me insane." With a sigh of relief, they moved on while I was wheeled outside to get in and out of a car.

The hospital staff realized early on that I was stable enough to stand without assistance from someone else, so they turned off the alarms that would alert them if I tried to get out of bed unsupervised and a sign was taped to my door to ensure I wasn't interrupted if ever I stood to use the bedside urinal. Somehow, the sign got moved, resulting in...

I guess they were supposed to

knock on my head? 🤔

I said earlier, I wished I'd done more poorly in terms of working toward my final evaluation. The reason why is because I was under the impression that I'd receive a wheeled mobility device when discharged, be it a wheelchair or a knee scooter. But because I did so well during my final evaluation, I was given a bare-bones walker. The exhaustive output level that I'd achieved during physical therapy was now expected of me every day until I was fitted with a prosthetic. At age 51 (at that time), with diabetic neuropathy significantly affecting my hand and arm strength - something they somehow didn't include in their final assessment - and being overweight due to a number of factors that I won't get into now, there was no way I was going to be able to maintain that level of activity.

This is a knee scooter.

This is an average, run-of-the-mill

walker. No AC, no BOSE sound

system, no undercoating.

What they also failed to realize was that there was always someone around during my physical therapy. If I started to lose my balance, someone was there to make sure I stayed upright. When I returned home, the only person around would be my housemate, and he worked 40-ish hours a week. His dog and my cat didn't really count in terms of helping me around the house.

Also, that PT to make sure I could get off the floor if I fell...? Well, I needed it almost immediately.

I'd been home a whole three days and was alone, just me and the beasts, when I decided to get a drink from the kitchen. On the way, I noticed the mat under the dog's food bowl was slightly out of place, making it a potential trip hazard. I made the brilliant decision to use one of the legs of my walker to straighten it. Did I brace myself against the wall? NNNNNNOPE! I skipped that rather vital step in the plan and went right for adjusting the mat.

It all seemed to happen in slow motion. One moment, I was standing on my leg. The next, I was gradually tilting toward the floor. The less-than-tender embrace of gravity took over, hastening my descent. I reflexively threw out my leg so my foot could stop my fall. A foot that was no longer there. As though it was scripted, I landed directly on my stump.

There are countless movies in the world in which someone receives a catastrophic injury and simply stands there, screaming. No words. Just a primal scream of agony. Somewhere in my brain, I always thought that was silly. Normal people don't just stand around and scream. They shout invectives. They mentally lock on to something and curse it as the cause of their misfortune.

That's what I thought before I fell. After I fell, I accepted that an uncontrolled, incoherent scream was a part of reality. I lay on the floor, screaming at the top of my lungs for a couple of minutes. The dog, of course, wandered over to let me know she was there to assist in any way she could, which was not at all. Sitting in the doorway to my bedroom was my cat, looking at me as if to say, "Great play, Shakespeare. What're you gonna do for an encore?" 

I crawled to where I could use the kitchen counter to get back on my foot. Sobbing, I collected my drink and returned to my room, where I took a fistful of painkillers.

Okay, I did NOT take a fistful of painkillers. I may be dumb, but I ain't stupid. I remember taking the maximum prescribed dose, even though it was about an hour early. My thinking was that the last dose would be wearing off soon enough, and I really needed the next dose to be working when that happened. HOWEVER, despite the fact that I suffered no detrimental side effects, you should NEVER, EVER overlap doses like this! That's how accidental overdoses occur. 

Something you may or may not have noticed... I used both terms "residual limb" and "stump" to describe what was left of my leg. There are a number of words and phrases in the amputee lexicon. If ever you talk to an amputee, you might want to ask what their preferred label is. Most, like me, probably won't care, but it never hurts to check. 

Here's where I'll end today's post. Coming up... A limb shrinker, a blister, getting fitted for a prosthetic socket, my first prosthetic, fighting to get the dang thing on right, and walking for the first time in six months.