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! 💖

The Good, the Bad, the Ugly... and They All Went to Med School

When I sat down to write this, I was hoping a word rhyming with "ugly" would come to mind that was relevant to the subject. Alas, my Muse is apparently on holiday.

As mentioned in my post a few days back, I thought about covering good and bad doctors. It then occurred to me that there was at least ONE that I encountered that would qualify as "ugly," because he was a good doctor, but was motivated by something other than helping sick people.

So let's look at "the good." I've had a number of very good doctors in my life. Hey! This is the perfect place for a list!

1. They should have gone to medical school. (I said at the very beginning of this blog that I would infuse it with humor! That you made it this far is YOUR doing!)
2. They should listen to your complaints and concerns without preconceptions. When I visit a new doctor and explain that I've only had success addressing my neuropathy pain with tramadol and they flat-out declare that they don't prescribe narcotics under ANY circumstances, I can't leave their office fast enough. They have this preconceived notion of "Narcotics bad!" My resulting judgment? "Doctor bad."
3. They suggest alternative treatments. Not "alternative," like essential oils or realigning your aura. I'm talking about treatments other than what you might have already tried. Like with the giant crevasse in my foot. The second wound specialist I saw suggested amputation out of the gate, but also suggested I consult a surgeon to see if there was another option. When I did, the surgeon suggested cautious optimism and exploratory surgery, not jumping to "lopping off my foot" as the only viable solution.
4. Good bedside manner. You don't have to be in a hospital bed to experience bedside manner. This is the doctor's general demeanor. Maybe you prefer a doctor who is extremely serious all the time, but I like them to have a sense of humor. At one point or another, I'll test them. If they can't even muster a smile, I'm never going back to their office.
5. COMMUNCATION! I don't know how many times I've brought up talking to your doctor openly and honestly, but communication is a two-way street. They need to be able to voice their own concerns about treatments, as well as ensure that you - the patient - understand what they're saying. Don't ever say that you understand if you don't! If the doctor needs to spend an extra five minutes explaining things to you, so be it. 
6. I can't believe I have to mention this one, but experience has taught me otherwise. Make sure they do an exam! I was actually discharged from an emergency room without ever seeing the doctor AT ALL! I'll tell you more about him in a short bit, but you've already read about this jerk in an earlier post.

I'm almost certain I'm missing a few things in there, but those are the basics.

To exemplify "The Good," I'll use a little anecdote about my current PCP. (Did I already use this one? I can't remember.) He ordered all sorts of tests. Blood and urine. No studying required. I was given the results by way of the patient portal. Looking over them, I took out a pad and made notes about those results that were highlighted in yellow. Even my Hgb A1c was yellow, even though it was 6.4. It's excused because the testing system isn't assuming I'm a diabetic. Because I am STILL not a doctor, I had to Google some of the tests to get an basic understanding of what the results meant. I mean, one test was labeled "Occult Blood," and I haven't sacrificed anyone to my Dark Lord in years!

Oops. I may have said too much. 😬

After every single one of my notes, I scribbled, "Cancer?" Yes, I included the A1c and the Occult Blood. (Occult Blood looks for blood in urine that may not be visible to the eye.) So when I followed up with him, I pointed out that I looked everything up and the online diagnosis was cancer. The highlights, of course, were the Occult Blood and A1c. For the former, I believe I said it must be demonic cancer. For the latter, I declared that I obviously had diabetes cancer... and cancer of the diabetes is very, very serio... It's silly. It's very silly. And the doc got a good laugh out of my shtick.

"The Ugly" is more of a story than a list, and so far there's only one doctor that ever qualified for this one.

I developed a kidney stone. After an ER visit and a CAT scan, I was sent to this guy because he was affiliated with the hospital. The stone I had was 3 x 7 mm. The male ureter - the tube where waste passes from your kidneys to your bladder - is about 4 mm. My stone was going nowhere without help.

The doctor I saw ordered some extra tests, including one where a camera was sent up through my... ummm... 

~ medical terms, Rob... think medical terms ~ 

...up through my winkie to look for any indications of stone damage or something. To be honest, I was too distracted by pain from the stone or too foggy-headed from painkillers to take notes. In the end, I saw him four times over a month and a half, including the procedure to look inside, which is considered surgical because I absolutely refused to be awake for that event. (I told him I didn't want to be conscious for that one, but he managed to not make a note of it, so I actually wasted a visit to his office, where he was prepared to do it in office, and I had to use little words that I use to explain to the simpleminded that that was NOT happening.) It was on the fourth and final visit to discuss the results of the procedure that he said, "You're going to have to go see a different doctor to get the stone out. Our hospital doesn't have the equipment to get it out."

I left his office utterly flabbergasted. He knew the size of the stone from the start. He knew his hospital didn't have the equipment needed to break up the stone and remove it. He knew the stone was causing me a lot of discomfort. But he saw me FOUR TIMES?!? Why? Well, that was obvious. To milk Medicaid for all the money he could get. Really, my visits tended to be very short, so he could bill them for his incredibly inflated fees for a three to five-minute visit. Only the procedure took longer, and his fee would be mixed in with everything else the hospital would bill insurance for.

Mind you, I'd been dealing with this stone for TWO MONTHS by the time he told me this. So he was a good doctor in that he knew what he was doing and was very friendly doing so... but became "The Ugly" with this final revelation. He also leans into the final category, since being motivated by money is obviously bad.

Now we come to "The Bad." Gods above and below, where do I even begin? I've met so many bad doctors in my lifetime that I think I've lost count. So I'll tell you about the first, one in the middle, and the most recent.

I was too young to understand what Dr. Needles had done during my diabetes diagnosis, so the first bad doctor I encountered was an attending during one of my numerous DKA hospitalizations. I believe I was around 15 at the time, and he'd prescribed bedrest for me. This was a first, so I asked why. His response was, and this is a startlingly clear memory in my head, "You're too stupid to understand why." And with that, he walked away.

For every action, there is an equal, opposite reaction. And my reaction was to call my dad, who in turn called the hospital with barely contained rage. Surprise, surprise, Dr. Snark was back two hours after his initial insult to apologize and explain that being up and about would only help the high levels of acetone in my bloodstream do more damage. I'm sure it was a shock to his ego when I told him that I was apparently NOT too dumb to understand.

The middle "doctor" is the one that treated me like a drug-seeking addict when I had that severe pain in the ball of my foot. (See my 13 August 2022 post, It Runs Deep.) Well, I wound up with this jackass again during an incident with my chest catheter. There was a build-up of pus - albeit very small - around the tube, and it had started stinging rather badly. The home nurse told me that her guidelines didn't allow her to see me if the catheter was becoming infected and instructed me to go to the ER. So I did, and Dr. Arrogant was the one assigned to me.

He never even came to see me visually! Sight unseen, he discharged me from the hospital. When I refused, I actually HEARD HIM proclaim to another staff member that they weren't a fast food join, so I don't get to have it my way. He then had security summoned to escort me from the premises. 

This did not bode well... for him. I allowed security to escort me out of the ER, and then to the nearest hospital administrator, where I had me a well and good heated rant. I pointed out that this particular ER doctor might very well be the cause for my osteomyelitis, which the chest catheter was being used to treat, and to discharge me without even SEEING me was fertile ground for a malpractice lawsuit against the doctor AND the hospital.

In an instant, I was treated like royalty... or as close as I would come to being treated like royalty. The administrator escorted me back to the ER and had a different doctor examine the port. I was entirely too angry to remember the rest of the visit, and I don't know what actually happened to Dr. Arrogant. At the very least, I'm hoping he was sent back to med school to retake the class about bedside manners. At the most, I hope he was dismissed with prejudice and wished well with his future as a janitor.

The final bad doctor I saw was a pain specialist. What makes this one special is that he was a bad doctor before I even made it to the office! I was referred to this pain specialist by my PCP, and a question was immediately relayed back to me through my PCP's office. "He understands we don't prescribe pain medications, right?" Yes, I was fully aware.

They immediately set up a hoop for me to jump through. My last spinal MRI - magnetic resonance imaging - was over a year prior, so they said another would be required. I deemed this so important that, instead of relying on public transportation, I took a cab to and from the hospital. With the test done...

No call from the pain specialist's office to schedule an appointment.

So my PCP's office called them again, and the pain doctor's office asked, "He understands we don't prescribe pain medications, right?" Yes, I still understood.

Still no call to schedule a visit.

My PCP called them a THIRD time, and Dr. Deaf's staff asked, "He understands we don't prescribe pain medications, right?" YES! GODS ABOVE AND BELOW, I'M LOOKING FOR TREATMENT OF PAIN, NOT A FIX! It's a safe assumption that if I was looking to get high, I could find a source on the streets that's a lot easier to access than this damn doctor's office!

To think, it only took three requests to get them to call me to set up an appointment. Again, I deemed this important enough not to rely on public transportation. I got there early enough to fill out all sorts of paperwork, including one that specified that they don't prescribe pain medications.

I was ready to use my go-to declaration of frustration, "You people are giving me cancer!" 

When the doctor arrived at the exam room, I was tempted to hold a mirror under his nose to see if it fogged, what with signs of life being rather important. (I should probably have included "be alive" as one of the traits of a good doctor.) He then proceeded to talk to me like I was a child learning shapes. When I said I understood something, he'd go on explaining further, almost like I hadn't spoken at all. When I did try to communicate my concerns, he would interrupt to say other things that had entered his head.

He was very nearly scraping the bottom of the barrel, when he finally shut up and began his exam. My primary complaint for seeing him was the perpetual pain in my lower spine. He tapped that area fairly gently, but I still jumped from the pain and joked about what he just did qualifying as "assault." He immediately stopped his exam to explain quite seriously why it wasn't assault. And I... was done. Even though he said he could probably treat my pain, he had evaporated any trust I might have had in him. I mean, when you go to see a new doctor, you have to have at least a modicum of trust, since they're likely going to touch you in places no other stranger would have access to the first time you meet them.

There you have it, ladies, gentlemen, and children of all ages. Just a little bit about good and bad doctors. "Just a little bit." Because in all honesty, I could tell you more stories the bad ones. The callous pain doctor that brought me to tears with his apathy. The doctor that fabricated her reasons for releasing me from her care. The doctor that threatened to spank me for my sense of humor.

No, wait. That last one was one of the good ones. 😁

Seriously, her staff bought her a paddle for her birthday as a joke gift for misbehaving patients and staff, which was written on the paddle! She pulled it out after we got the results of an AIDS screening. There was no real reason for doing it, but when it came back negative, she demanded I keep it that way, and I joked, "No promises." Out came the paddle! 🤣

Oh... and a little edit of information. Remember in my last post, how I ranted about the annoyance of glucose testing supplies being undeliverable? I learned that the legislation was reversed a month ago. So one of the main reasons that I, a BK amputee, worked so hard to get the scooter was eliminated with absolutely no fanfare whatsoever.

Now, I know I've been promising the beautiful, scantily clad young woman for many of my posts. Well guess what I found on the internet!

Boobies!

I know, boobies are all over the internet,

but this includes baby boobies!

Wow, that sounded bad. Apologies.

The Best Bad Development Yet

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

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

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

It is NOT beyond the realm of possibility.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

I'm gonna go cruisin' for chicks with

this baby!

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

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

There she is... but annoyingly

overly clad.

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

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.