Heart Broken

Yeah, yeah. "Heartbroken" is one word. Since I make an effort to choose my words with care, (although you'd never know it with some of my typos), I'm not writing about a failed relationship. In fact, I'm not really talking about my heart in this post, but my vascular system. Still, it's a cardiologist who oversees my "heart" disease, making the post's title appropriate. So nyah! 😛

It was probably about 10 years or so ago when I was prescribed my first bottle of nitroglycerin, (commonly called "nitro" to save on syllables). Yes, I'm one of millions of people walking around - "hopping around" in my case - with what is supposed to be an unstable explosive compound in my pocket. Well, kinda. Through some kind of pharmacological voodoo, the compound is rendered harmless in terms of explosions and such.

The reason it was given to me was because I was experiencing an occasional tightening sensation in my chest. Nitro is a vasodilator. If you've ever had your pupils dilated, then think of nitro doing that, but to blood. However, my symptoms were so infrequent that my past PCPs never thought it important enough to recommend I see a cardiologist.

And then the frequency started to increase.

There were other factors besides symptoms that pushed me to see a specialist. First and foremost is my family's history with cardiovascular disease. My paternal grandfather died from a sudden heart attack at 65. (Might have been age 60, but that's because one memory collided with another and the math did strange things inside my head.) My father was in his 60's when he had to have a triple bypass and mitral valve replacement. My brother, two years younger than me, tore his ascending aorta while he was... ummm... Well, he and his wife were alone, and... uhhh... Y'know, doing married couple stuff. As I understand it, his condition should have been fatal. By some miracle, he lived. So, yeah. The men in my family didn't have a good history when it came to cardiovascular health.

Another reason was that I was 50 when I asked my PCP to refer me to a heart doctor. The big 5-0 is when you should really start paying more attention to the possibility of a number of illnesses, including heart disease. Doctors can perform basic tests to monitor for such conditions.

Finally, just in case you didn't already think of it, I wanted a heart doc because I'm a diabetic. A lack of glucose control can force the restructuring of existing blood vessels, so heart disease is almost inevitable for diabetics. Almost. 

The thing that my brain latched on to was that doctors and nurses kept referring to the tightening sensation in my chest as "pain." Silly me, I would try to correct them that pain hurts, and this didn't hurt. It just felt uncomfortable and worrying. Eventually I recalled heart attack victims describing that it felt like an elephant was sitting on their chest, so... Yeah, I guess it really was a kind of pain.

My newly acquired cardiologist ordered some tests, including a stress test. This is where they usually force the patient to be active briefly, and then record how the cardiovascular system handles it. I, however, had to be the difficult patient, what with me dealing with the giant hole in my foot. The stress on my heart had to be chemically induced, and... it did not feel good. It was unnatural to be sitting still, engaging in next to nothing except conversation with the technician doing the test, when suddenly my whole body was flushed with blood, my heart pounding away. 

The result of the tests indicated that heart disease was indeed settling in, but my doctor believed it could be managed with medications. He put me on a cocktail of four different medications and scheduled a follow-up appointment.

On my next visit, I still wasn't feeling quite right, so he increased one of the medications.

Rinse and repeat for the next visit, with the same medication increased.

At that point, I felt okay. Reaching for a nitro tablet became a rare occurrence.

Then COVID-19 decided to enter all of our lives. I had the pandemic trifecta of pre-existing illnesses that would make for miserable circumstances if I should catch it. Diabetes, overweight, and cardiovascular disease. By some miracle, I didn't catch it. But the stress of its very existence started doing that thing to my chest again. So when I called the cardiologist to let him know what was going on, he deemed it time for us to do an angiogram so he could see what was going on inside me with his own eyes.

I knew the basics. He'd go in through an artery and have a look around. What I did NOT know was that his exploration would be broadcast onto a huge TV screen right there in the catheter lab and that I'd be pumped full of blood thinners. They gave me a bit of sedation so mild that I didn't really feel its effect at all.

Here's what we learned. Keep in mind that he didn't name the arteries, only calling them "the first, second, and third." 

The first was in good shape. Not GREAT shape, just good shape. 

The second required the placement of a stent. This involved him sending in a balloon surrounded by a metal mesh and positioning it where a blockage was forming. He inflated the balloon, widening the artery and supporting that widening with the mesh. How the stent stays in place is something of a mystery to me, but it stops that artery from narrowing again. This part of the procedure meant I'd be on blood thinners for the next year while new arterial tissue grew over the stent.

The third artery... Ohhh, that third artery. Totally, completely, 100% blocked. He even had me look at the screen so I could see him bumping the wire probe uselessly against the blockage. But while that blockage was forming, my body took the initiative and tried to effect its own repairs. I have collateral arterial growth that bypasses the blockage. However, this isn't the good news it sounds like. Do you remember, even vaguely, when I talked about neovascularization in my diabetic retinopathy post? Like the new blood vessels in the eye, the new arteries aren't as good as the original equipment. In fact, when the doc was starting to explain the collateral arterial growth, I asked, "Like neovascularization in diabetic retinopathy?" To which he replied, "Exactly."

This procedure should have been an in-and-out experience, but I just had to be the troublesome patient. My blood refused to clot, so I kept bleeding from the hole in my wrist where he'd entered my vascular system. I was kept overnight, with nurses checking on my leaky wrist every two hours.

If you're ever hospitalized, remember that you're not there to rest; you're there to get well. And if that means a nurse interrupting your sleep every two hours, so be it.

So that's my tale of how I was officially diagnosed with diabetic heart disease. What makes this different from regular heart disease? I'm a diabetic. That's it. It's probably not REALLY diabetic heart disease, but the fact that I'm a diabetic means the word "diabetic" is likely to be thrown in front of every diagnosis I receive.

Before I go, this...

You didn't think I'd be serious,

at the end, did you?

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. 🙂)

Diabetic Retinopathy: Seeing Is Believing

Welcome back! Ready to be terrified? Oh, you're not? That's a shame. I have little else on the menu but terror. Maybe you'll get a taste for it as I go on.

I know, I know. "Don't quit my day job." But thanks to diabetes and a few other issues, I'm disabled, so I can't quit my day job. So nyah! 😝

Now where was I in my retinopathy story? ~ mutters while reading ~ Peroxide... eye doctor... puke test... early detection... ~ speaks up ~ Right. I'd started going blind. Slowly. Very slowly. Very, VERY slowly. And somehow I managed to subconsciously dismiss the seriousness of my retinopathy. As a result, I still wasn't taking very good care of myself. Cheating on my diet, late insulin doses, not checking my glucose at all. I think if my vision were worsening rapidly, I'd have taken it more seriously early on. 

But by the time I started doing that, it was too late. The damage was done. I didn't need to see an ophthalmologist to hear about the troubles brewing in my eyes. Any optometrist, who I'd be seeing just for new glasses, could see the damage without dilating my pupils. 

My every visit to an ophthalmologist filled me with fear. I didn’t want to know how far my eye disease had progressed. I didn’t want to face it. The hours that would follow such doctor visits are filled with tears of anguish and guilt. I did this to me. Not some nameless deity, not family, not friends. Me! The fear of losing the precious gift of sight was terrifying. There is a beauty to the human body, a kind of wonder that such a complex machine can exist and function the way it does. Seeing a human being grow from child to adolescent to adult is wondrous to me. Watching the miracle of the seasons change… Or to see such marvels as the Red Rocks in Arizona… The beauty of the rising and setting sun…

Sickeningly sentimental? Maybe. But wait until it starts happening to you and see where your mind starts to wander.

Remaining watchful eventually clued us in on the next step in keeping my retinopathy managed, which was lasers to cauterize any hemorrhaging in my eyes. Not "pew-pew Star Wars" lasers. Silent beams of light that can hurt when concentrated in a single part of the eye.

For quite some time, I'd be able to face these treatments with a degree of humor. One doctor even offered to make the Star Wars sound effects after I brought it up. But then something unrelated to diabetes put the nail in the psychological coffin labeled "post traumatic stress disorder." Suddenly the laser treatments were akin to actual torture. 

One of the doctors I saw would have a nurse stand behind me with a hand gently resting on the back of my head so I wouldn't pull back from the laser. There was absolutely nothing aggressive in their behavior. But my subconscious translated the entire experience into full-blown terror. It translated the entire scene into me being held against my will. I'd find myself crying uncontrollably after each treatment, and it once got so bad that I tossed my cookies.

Eventually, I graduated from lasers to... You ready for this? INJECTIONS! You're saying to yourself, "Rob, we're diabetics. Injections are what we do." And I get it. No big deal... until I tell you that they're injections made directly into the eyes.

May all of the gods in every existing pantheon bless Dr. Roy! (Not his proper name.) His voice was so calming that I flat-out told him it could be used as a sedative. Seriously, the man could tell you that you have five minutes left to live and you'd be perfectly okay with it. So when he suggested injections of Avastin, I agreed without a single complaint. He said he was going to inject my eye and I was fine with that!!!

Avastin was FDA approved 16 February 2004 as a treatment to starve malignant tumors, thereby shrinking them. (It's WAY too technical.) I can't find an exact date, but Avastin was approved for off-label use in 2005 for vascular eye diseases because it helped restrict neovascularization. (Again, too technical, but that's what I got from my research. Keep in mind I'm NOT a doctor!)

So how does one get injected in the eye? This is how it happened for me. I'd be given anesthetic drops in the affected eye, and the area around the eye was cleaned with iodine. Dr. Roy would come in, tell me to look up and away from him, tell me to stay VERY STILL, use an applicator to put a tiny dot of iodine directly on my eyeball, and then inject that site. Scary as heck. Easy as pie. The worst part...? If the exterior of my eye was cleaned a bit overzealously and more iodine wound up in my eye. Despite the anesthetic, it would BURN! 

Now you might be wondering what prompted the need for these injections. Well, when those weakened vessels I mentioned last post would start to bleed inside my eye, the blood would get suspended in the vitreous gel of the eye, creating a kind of psychedelic black spot in my vision. "Psychedelic" because I always saw it in 3-D when I'd concentrate on it.

That's the worst of it, right? A couple of shots a year in the eyes. Diabetics do shots. No big deal.

Until the shots don't work. That's what happened to my left eye. Despite receiving several injections over a six-month period, it was still hemorrhaging, obscuring part of my vision. The time had come for a vitrectomy.

I joke about it today. Because it sounds similar to a different surgical procedure men can have, I'll tell people, "I can't get you pregnant by looking at you." It usually gets a laugh. But when it was happening...? 

Let's see how funny you find the procedure. It all takes place in a hospital operating room, so there's all of the fun that comes with hospital pre-op. Sedation is given, but you are not knocked out! They need to awake so you can keep your eye from moving around. They give you juuuust enough sedation to keep you from freaking out completely. They do a block on the optic nerve, which means a facial injection below the eye. Next - and now we're really having fun! - they clamp your eye open. After ensuring you cannot blink, the doctor instructs you to look up and away, just like when you received Avastin injections... except you're about to hold your eye in this position for 30 to 45 minutes. Every now and again a nurse lubricates your eye to keep it from drying out. Meanwhile, the doctor has poked a few instruments into your eye and is removing the vitreous gel from the middle of your eye, replacing it with water. They're also carefully peeling away problematic layers of neovascularization. So far, so good... until you start calmly saying "Ow" to let the doctor know your eye isn't numb enough. Remember that they have to work under certain safely established parameters. "The patient gets X-amount of local to numb the eye." But because every patient is different, that safely established dose may not be enough. Thus, every time I calmly said "ow," I was given more local. And you have to say it calmly because the very last thing you want to do is startle the doctor delicately working on your eye. 

If you have to endure this procedure, it will be the longest hour you've ever experienced. You know how time becomes distorted during different experiences. I usually use this as an example: The length of a minute increases exponentially when you're on the wrong side of the bathroom door and really have to go while it's occupied. 

Wow, this is long. I usually cut it off now, but sharing misery and terror is becoming one of my favorite hobbies. 😉 You're welcome.

Post-op, my eye wasn't completely filled with water. There was juuuust enough air in there for a bubble to reside... at the BOTTOM of my vision. Your visual input is actually upside down and the brain flips the image so you're not living in a perpetually upside down fever dream. But that air bubble existed in the part of my eye before the point where my brain could rectify what I was seeing. As a result, the air bubble at the top of my eye was always at the bottom of my visual field.

Has any of this shocked you? Scared you? Made you think, Maybe I should monitor my diabetes a bit better? Well then, allow my to put a cherry on top of this crap sundae.

Without any vitreous gel in the center of my left eye to suspend the blood if I started bleeding in there, the blood would simply permeate the center of my eye. And that's exactly what happened about a month after the surgery. One minute I was using my eyes quite normally, and the next the vision in my left eye started disappearing. I was completely blind in my left eye in about 15 minutes. At best, I could only distinguish between light and dark.

Okay, okay. Relax. Breathe. It's terrifying, but still fixable. (That's for you. There was no way I was thinking that calmly as my ability to see faded.)

I called my doctor's office and reported what happened. He was able to see me the next day and give me another injection of Avastin. It took a few weeks, but my vision eventually cleared up. Miraculously, I haven't had a repeat of that incident.

Other optical issues sprung up almost immediately. Fluctuating blood sugars can lead to other structural changes in the eye like... Oh, I dunno... Let's say cataracts. Dr. Roy was amazed at how fast I started developing cataracts in BOTH eye post-vitrectomy, stating that it was like my eyes were sprayed with Miracle Gro. Alas, that wasn't something he handled. I had to go to a completely different eye clinic. They removed the lens of my left eye and replaced it with a generic lens. Two weeks later, they did the right eye. Those procedures were so fast that I joked they could have done them as a drive-thru service.

Because I received generic lenses instead of custom lenses, I was forced to get trifocals for my next pair of glasses. But thanks to the vitrectomy, my water-filled eye absolutely refuses to cooperate with the new lens enough to provide me with 20/20 vision. The best an optometrist can do for me is 20/30. With most daily activities, that's not a big deal. But for an avid reader like me, it's a pain in the tuchas because I can only read using one eye.

And that's where I am in terms of diabetic retinopathy today. Some of you may be thinking, That's not so bad. You got everything fixed. Yeah, but... What if I experience another bleed in my left eye and an injection doesn't fix it? What if I have to have another vitrectomy, leaving both eyes filled with water... and then I have fresh bleeds in BOTH eyes? In no way am I prepared for the world to disappear.

Okay, I think that's more than enough for this post, but I need a better ending. Something light. I mean, we're talking about eyes. Maybe something visually appealing, like a scantily clad young woman. Yes, that would be absolutely perfect. Here you go:

A T-rex in an ugly Christmas sweater?!?

Honestly don't know how I screwed that up.

Must be issues with my eyes. 😉

Diabetic Retinopathy: A Sight to See

"Diabetes can cause blindness." That line is simultaneously a dire warning and the dumbest thing anyone can say. Then again, A LOT of statements about the complications of diabetes are stupid. "You could wind up with a foot being amputated." "Your kidneys could shut down." Here's one to dread: "You could experience erectile dysfunction." (If you're of the female persuasion, don't laugh at the plight of me. When I cover neuropathy, you'll learn that you don't escape sexual dysfunction, either.)

Want to know why such statements are stupid? BECAUSE NO ONE EVER EXPLAINS HOW THOSE THINGS COULD HAPPEN! And all of those things "could" happen. Allow me to correct those statements. If you don't manage your diabetes, those things WILL happen!

Am I trying to scare you? You bet your sweet bippy, I am! Because if someone gently takes your hand and tries to sweettalk you into taking care of yourself, there's the inclination to dismiss the warnings. And if the person warning you isn't a diabetic...? Then really, what the hell do they know? "How many years of pre-med, med school, and internship? THEY KNOW NOTHING!" 

But how about a warning from a diabetic who's been through it? It's a very different story, because now it's not the voice of education and research. It's the voice of experience.

So buckle up, my non-existent audience, as I tell you about the very first complication of diabetes to affect me.

I was 24 and working for my father. Up at 6:30, groggily get my contacts in, get dressed, stop at a deli for some form of breakfast, and then make the 45 to 60 minute drive into Brooklyn. There's one word in that last sentence that complicates matters. "Groggily." My contacts would sit overnight in a peroxide solution that would be turned to some harmless chemical by morning. I'd rinse them with saline and pop them into my eyes. But you know what was missing at the time? A way to differentiate between the peroxide solution and the saline. Same-sized bottle. Same screw-top caps. Same white color.

And so it was that I rinsed my lenses with the peroxide before popping them into my eyes. Boy-howdy, did that hurt! When I finally cottoned on to my error, I rinsed the lenses and my eyes directly with saline, and then went off to work.

Note: they eventually made the spout on the peroxide solution a bright red.

By the time I'd arrived at work, my eyes were no longer burning. Dad was already there. He asked how my morning was going, to which I reported quite casually how I'd almost chemically burned my eyes out of my skull. Dad was WAY less casual! He made me go home and call an ophthalmologist.

I went home, called an eye doctor, and was told they could see me in a month. A month. So I used the magic words that habitually opened a doctor's schedule instantly. "I'm a diabetic." And what do ya know? They had an opening that afternoon!

When I saw the doctor, he said that there was a degree of extremely mild irritation still visible, but complimented me on having the presence of mind to rinse using saline. No, nearly burning out my eyes was less a concern to him than the beginnings of diabetic retinopathy.

Okay, this gets a wee bit complicated. Lack of control of diabetes causes damage to small blood vessels. Exactly how the damage is done is far too complicated to describe here. I’ve tried researching it, but I lack a medical degree to make heads or tails of it all. To quote one of my online sources, “Diabetic retinopathy is the result of microvascular retinal changes.  Hyperglycemia-induced intramural pericyte death and thickening of the basement membrane lead to incompetence of the vascular walls.” I can do the “medical speak” fairly well, but I have my limits. The best I can tell you is that the eye is filled with microscopic blood vessels. Damaged vessels become weak, will balloon, and even hemorrhage. These leaks tend to scar the retina. But wait! It gets worse! You see, the eye needs blood and oxygen delivered to the right places in order to function. The loss of this optical nourishment is called ischemia. In a wondrous little process called neovascularization, new vessels start growing in the eye. Good news, right? Wrong! These new vessels are weaker than the original blood vessels. They, too, will hemorrhage, and usually much easier than the original equipment. Eventually, blood will flow into the vitreous gel of the eye, blocking vision. The scarring that can occur without treatment can cause the retina to detach. The happy little visual receptors, commonly known as rods and cones, stop working because they are no longer attached to the cells beneath them. These detached areas become blank spots in the vision. Get enough of these areas and the diabetic becomes completely blind.

I’ll try to simplify this. And please, for the love of everything good in the world, don't try this! Just imagine it. 

Let’s say we’re not talking about the microscopic parts of the eye, but a finger. Imagine taking a rubber band and twisting it around your finger until you cut off the circulation, and then leaving it like that for a good 72 hours. Choking off the blood supply to your finger would cause your flesh to literally die, and you’d soon find yourself facing surgery to remove it. That’s what happens to the eye. It loses its proper supply of blood, effectively “killing” the cones and rods. The retina detaches, creating a very blind diabetic.

A little comparison for you. Enjoy it while

you can still see.

Back to the diagnosis...

It’s strange how the mind works. I didn’t know all that much about retinopathy back then. All I knew was that it was the cause of diabetic blindness. Here’s what the doctor said: “We caught it early.  I want you to get a fluorescein angiogram.  We’ll follow up in a few months.” Here’s how my mind translated it: “We caught your blindness early. I want you to get a fluorescein angiogram because you’re going blind. We’ll follow up in a few months, when you may start to notice that you’re going blind.” 

What does a tough guy from New York do in the face of adversity? Go home and weep, obviously! I didn’t associate my eye problems with the fact that I took terrible care of my diabetes throughout my teen years. Weeping as if the end of the world was nigh, I blamed every single living person and every god in every pantheon I could think of.

Then there were my friends, bless ‘em. There’s nothing like a little dark humor to shed light on my terrors and banish them… temporarily. They spent hours after I shared the news making terrible jokes about getting a seeing eye dog that would bark so many times to rate the beauty of women I could no longer see. On a scale of one to ten, one bark meant run for the hills and ten barks meant she definitely worth sleeping with. (Like I'd care about looks if I was blind.) Jokes even greater in their lewdness followed about “seeing with my hands.” To them, it was the perfect excuse to feel-up numerous women and have a legitimate excuse. After being humored enough, I joined in, suggesting that I wasn’t blind yet, but it made for a great pick-up line. “Excuse me, miss… I’m going blind, and I wish to see as much beauty as possible before that happens. Would you allow me to see you naked?” It was cheesy, but it got laughs.

The fluorescein angiogram was my next adventure. My father went with me, as I was told I wouldn’t be able to see properly for four to six hours after the test.

We got to the test center, signed in, and waited. And waited. And waited.

I got hungry, so I went to the cafeteria and had a tuna sandwich. I remember exactly what I ate, and you’ll understand why shortly.

Upon my return, I was given drops to dilate my pupils. After the drops were applied and starting to take effect, I was handed a piece of paper to read about the test I was about to endure. Couldn't let me read that beforehand, right? The information sheet said I could expect to pee orange for twenty-four hours after the test, and that three percent of all patients experience nausea from the dye that’s injected into the blood.

No problem. Peeing orange might be entertaining. And the nausea? I’d been nauseous before. With my seemingly perpetual bad luck, I’d be part of that three percent, so I’d be nauseous for a bit. So what?

One other thing to note before I go on: bright lights and dilated pupils don’t go well together. Bright lights can actually be painful.

The test took place in a room the approximate size of a sardine can. They set up an IV line in my arm, had me rest my head in a frame that would help me hold still while they took pictures of the inside of my eye. I was all set. They camera was ready. The technician was ready. The nurse was standing by to inject the dye. Once in my blood, they would have only a few minutes to snap their pictures before the dye was diluted too much to be worth anything.

The nurse injected the dye.

I was perfectly fine before the dye went in. But remember the warning about possible nausea? Not only was I part of that three percent, but I discovered it was much more than mere nausea. It hit like lightning once the dye was in me. I started vomiting without any delay, and I couldn’t get my head in the nearest garbage pail fast enough. This is why I can recall exactly what I ate at the cafeteria. It involuntarily came back for seconds.

So I’m puking, the technician is explaining quite firmly that I have to stay still for the test. Then he shined a light that I would have sworn was brighter than the sun in my eyes and snapped his pictures.

Puke, blinding light, snap. Puke, blinding light, snap. Puke, blinding light, snap. 

I was sure on the next fluorescein angiogram to go with an empty stomach. While extremely nauseous, there was no vomiting.

Such a description might tempt other diabetics to avoid this test. I’m almost willing to agree with you on that one… except there’s a necessity for having it done. You wouldn’t want a doctor to treat something as delicate as your eye using guesswork, would you? Especially if your power of sight hanging in the balance? (You should be answering “no” to both of those questions!) The fluorescein angiogram provides an interior map of your eye to the doctor, allowing them to see which pathways have been damaged and what can be repaired.

In the end, there was nothing much to worry about. Did I have retinopathy? Yes. Was I hemorrhaging yet? No.

This is a pretty long post, and I still have so much more to say about retinopathy. Because this isn't the scary stuff. This is early detection and preliminary care. The scary stuff... is coming.