Yet Another "Happy" Anniversary

Hey. How are ya? You good? Good, good. Glad to hear it.

Me? No, not good at all, really. Y'see, today makes it four years since my left foot was amputated. So, yeah. Not a great day.

I've already told the tale. How my growing concerns post-op on my left foot were dismissed, only to discover a fissure had opened up on the sole of my foot. But in a way, I was lucky. I had just over a year to grow accustomed to the idea that I'd lose the foot. A lot of other people have that kind of thing come as a surprise. I have an ex who was told she had to lose her leg, and that she didn't have much time to decide. The osteogenic sarcoma (cancer) in her knee was VERY aggressive. In fact, in the short time she thought about it and finally agreed, the cancer had moved another inch and a half up her thigh. They ended up taking 90% of her left leg.

Facebook brings up the memories from that time of my life, and I was a psychological mess. 

20 Oct 18: The tears are starting to come much easier now. I was never going to lose a foot because such things would never happen to ME. Amputation was for OTHER diabetics. And while I've had quite a few scares, it was always a bullet I'd successfully dodged. Not this time. Last night, while simply sitting here, I could "feel" the foot gone. Not post-op pain, as that seemed to be beyond the realm of my imagination. I was simply imagining my foreleg coming to a sudden stop mid-way.

Two days later...

22 Oct 18: My nurse after getting a blood pressure of 112 over 68: "You are Spicoli levels of chill."

I don't know. Maybe it was an acceptance of my fate. Maybe it was only a brief calm amidst the storm of emotions I was experiencing. I knew my life was about to change radically, I just didn't know exactly how.

Well, I found out. Tasks that were so simple became tests of balance and endurance. In the hopes that my friends would understand, I would give them a simple challenge: make a sandwich from start to finish on only one foot. That is, from the moment they entered the kitchen to the moment they sat down to eat the sandwich, do it without their raised foot EVER touching the floor. If the raised foot touched the floor, it counted as a hard fall. No one ever reported back if they'd tried it. Maybe they only imagined it and thought that was enough.

Because I lived through that challenge for six solid months, it's no wonder I was so excited to be able to do dishes when I got home with my first prosthetic. Seriously, when I got home, I dropped off all of my prosthetic supplies in my room, and then immediately went to the kitchen to do the dishes. 

The exciting life of an amputee.

And then there was THIS annoyance:

A pic I took the day after I got home

from surgery.

This seemingly innocuous picture is of me trying to cross my legs. Four years later, I still can't adjust to the idea that crossing my legs shin-to-calf is an impossibility unless I'm wearing my prosthetic.

I'm sorry there isn't any humor in this post. I usually try to crack wise at least once, but this one's just too hard. Maybe next time.

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.

Please Kill Me

Hey, I'm asking nicely. That's gotta count for something.

The thing is, I'm writing under duress. I am NOT well. I believe I've mentioned diabetic gum disease previously, which is plain old gum disease put in a shiny "diabetic" wrapper. Well, I have a doozy of an infection going on right now.

It started, much to my dismay, when one of my molars snapped off at the gum-line. How any tooth decay was occurring without me feeling exceptional pain is a mystery. But the tooth cracked apart, leaving just the roots behind.

No problem. I wasn't in pain. Life would go on.

Until it didn't. It takes a special level of stubbornness to be aware of how much risk diabetes puts me at, and then willfully ignore it for even a minute. But that's what I did, allowing something to get into the disaster area where a tooth once resided. It could have been the tiniest particle of food. I don't know. But I soon found myself writing to my doctor via the patient portal to ask for antibiotics for a gum infection.

This infection, however, is on steroids or something. The pain kept increasing and the area started swelling. That popular pain scale of 1 to 10 had me reporting to my doctor that I was experiencing a 10. I couldn't concentrate on anything. I was falling asleep only when I was completely exhausted. And the local dental clinic...

The local dental clinic is understaffed and overwhelmed. I have been calling them early in the day to try and get one of their daily emergency slots, but because the entire town is calling at the same time, I could never get through. When I finally DID get through, they set up an emergency appointment for me... at the start of November.

Because I needed immediate help, I went to my PCP. My hope was that he'd numb me up with lidocaine. My hopes were dashed, but replaced with something better. Toradol! This is an anti-inflammatory that can be given intravenously or intramuscularly. (In a vein or in a muscle, respectively.) Within 15 minutes, all of my major aches were put on hold as it took effect. 

Not every excellent painkiller is an opioid. 😉

He also gave me a shot of penicillin. Medications that are injected tend to be more effective than those taken orally. To go with the shot, he ordered up a stronger oral antibiotic at my pharmacy.

My discussion with the doctor included some warnings. If the pain didn't get better. If it became more intense. If the swelling increased. If I started running a fever. If I lost complete control of my blood sugars. If any or all of these ifs came to fruition, go to the emergency room. Because they could indicate the infection is settling into deeper soft tissues.

All of that was on Thursday afternoon.

Here we are on Saturday, and - PLEASE, FOR THE LOVE OF ALL THE GODS, KILL ME! ~ ahem ~ That is, things are a bit different. The swelling has gone down and the pain has... diffused. I can actually poke at the trouble spot and feel very little pain, but much of the left side of my face aches. A LOT! I feel feverish, but I've checked my temp three times today and I haven't cracked 98.4 F. (36.8 C for any of you Metricans out there.) Overall, I feel mostly terrible.

Now comes the silly, stupid debate in my head. Reasons why I SHOULDN'T call an ambulance:

1. It's less than 48 hours since I received that penicillin shot, and just over 24 hours since I started the stronger oral meds. I should give them more time.
2. Not knowing if they'd admit me, I should probably pack a bag... but I desperately need to do laundry. Right now, I have nothing to pack.
3. There's the possibility that I'm not actually sick enough. I'd hate to go to the ER and waste their time.
4. I would have to call an ambulance to get to the hospital, and I simply don't feel like my current ailment is a valid use of their time. There are heart attack victims and people getting into car accidents. They need an ambulance more than I do.

Okay. Reasons why I SHOULD call an ambulance:

1. I feel super-mega-icky!

Foolishly, I'm going to hold out another day or two to see if I improve. If the pain intensifies or I finally DO crack a fever, which most hospitals define as 100.5 F (38.05 C), I won't hesitate to call for help. But right now, I feel like this illness isn't well-defined enough to warrant emergency care.

"Rob, this is all terrible for you, but... ummm... this is supposed to be your blog about diabetes, remember?"

Trust me, I haven't forgotten. I DID start off talking about diabetic gum disease, and you may have missed it, but one of the reasons I should get to the hospital is if I can't control my blood sugars. That's because infections can do a number on glucose control. Your body will throw glucose reserves into your bloodstream to provide enough energy to fight the infection. Poor glucose control is a perfectly valid reason to seek medical help, especially when you're more accustomed to having good control.

That's what I got for today, loyal reader... Assuming any of you are, in fact, loyal. As I depart, I leave you with the most appropriate paint job on a Ford Pinto ever:

If you know, you know. 🤣

Recognizing My Dumb Mistake

It's not easy to look at your own reflection and say, "You knew better, but you did the dumb thing anyway. Are you going to own it? Or are you going to deflect?" And lemme tell ya, I wanna deflect. "No, I didn't do anything wrong. It was the capricious nature of Fate that made my life so difficult." I could then go on to deny any knowledge of what was happening, blame things on my goofy metabolism, and continue blissfully onward... all the while knowing deep down that I was screwing up.

Wow, that was a good opening. I'm gonna end the post there. I don't want to ruin it with words that might upset me.

Well, obviously I can't just end the post. I used a lot of words, but didn't actually SAY anything.

So here's the scenario: Late in the evening, feeling like I've been a good diabetic all day, I decide to treat myself to things that aren't approved for a diabetic diet. Sometimes it's garbage that is better left to the diets of children. Sometimes it's a serving portion that's slightly excessive. (I'm weird, and a larger bowl of Wheatena before bed appeals to me for some reason.) Because I sometimes play guessing games with the math, I take a dose of insulin that I THINK is going to cover me. And when I wake up in the morning, my fasting blood sugar is abnormally high.

Here. These are my fasting blood sugars for the mornings of September 16, 17, and 18 respectively: 248, 342, 400. (It's so weird to get a number as neat as 400, even if 400 is so bad for me.)

After my realization of what was happening and working things out, these are my fasting blood sugars for the mornings of September 22, 23, and 24: 140, 97, 86.

So where was I going wrong? The easy answer is that I was eating too much before bed. But the evidence against that idea is that I'd stopped that practice altogether on the night of the 18th, and my fasting sugars for September 19, 20, and 21 looked like this: 302, 257, 224. That's because, out of habit, I was still taking just a little extra insulin with my evening snack.

Did you catch that? My morning blood sugars were high because I was taking too much insulin!

"But Rob, that makes no sense. If you're taking too much, your morning blood sugars should be REALLY low!" 

You'd be correct, if not for what is known as the Somogyi Effect. The simplest explanation is that while the diabetic is asleep, they become mildly hypoglycemic. As a result, the body releases glucagon to bring the glucose levels back up. The diabetic never feels a thing until they wake in the morning with all of the ugliness that is hyperglycemia.

How did I fix it? (It's list time!)

1. Stop eating random amounts of carbs before bed. Whether it's three or four "breads" on the diabetic exchange diet, I keep it as exact as possible. That means nothing that requires guesswork, like random amounts of hot cereal or leftover pizza.
2. Calculate my insulin dose exactly. No random additions of "just a few more units to make sure I cover X amount of carbs." Account for what my glucose is at the time of the meal, as well as the carbs I'm about to ingest, and NO MORE THAN THAT!
3. Adhere to these steps religiously. It's a pain in the tuchas. It means relinquishing some of the freedom I've felt since taking a proactive stance on my diabetes maintenance. But if I'm not awake to make adjustments on the fly, I'm putting my overall health at risk. And that means...
4. If I'm going to be a bad diabetic, be bad during the day, when I can feel most of the effects of my glucose rising and falling. Well, mostly rising. Falling, as mentioned in my 20 September post, is becoming more and more of an issue.

Of course, suddenly realizing I've been dumb and waking with good fasting glucose levels left room for me to be silly, which is why I was able to post to Facebook on the 23rd...

I wouldn't throw it away! That stuff is worth

more than gold!

Besides, if I told you how much insulin I took to get that 86 for lunch, you'd think I was attempting suicide by insulin. But that's a topic for a different day.

EDIT: Funnily enough, this post is coming after I've written about the absurd amount of insulin I take for a cup of coffee. I originally wrote this post on 24 September, but then got distracted by other things. My apologies.

And as I end this blog, and this is completely unrelated to diabetes, but...

This is gh0xttherebel.

He's been reacting to my favorite American anime, RWBY. His reactions have been absolutely incredible, and his editing skills are off the charts. gh0xttherebel is the channel's name, so if you want a laugh while watching an excellent show, go check him out.

For Want of a Cup of Coffee

I know what you're thinking. "Rob, you absolute paragon of diabetes control. You're like a divine presence come down from the Heavens to lift us up with your stylistic ramblings and fill our heads with important information about diabetes." Yup. Guaranteed, that's what you're thinking, word-for-word. 😉

Okay, so I'm not exactly a psychic. But I have the distinct feeling that some of the people reading this blog might think that I think I'm the patron saint of diabetics. 

Not even close. I'm a good diabetic most of the time. But some of my choices fall under the category of "Do as I say, not as I do."

My last post was about my diagnosis of cardiovascular disease. If you don't know, such a diagnosis comes with even more dietary changes. Reduced fat. Reduced salt. No caffeine. They might as well have told me I'm only permitted to drink water and eat nothing but cardboard. What's funny is that these restrictions are already built into a diabetic diet in hospitals. I found that out when I had to stay the night after the angiogram. They sent me a meal that was labeled "heart healthy," but with packets of sugar and a fruit cup loaded with fructose. So I called down to let them know that my meals should also be for a diabetic, and that's when I was told the diabetic menu was even more restrictive than the heart healthy one.

Reduced fat, reduced salt, no caffeine, and NO SUGAR! 

Now it's the water and cardboard diet, for sure.

During a follow-up appointment with my cardiologist, I credited him with bringing my blood sugars under tighter control. He initially rejected this idea until I explained that with my cardiovascular system no longer struggling as hard to function, the overall stress on my body has been reduced. Similar to the "fight or flight" reflex, my body was in near-perpetual "fight mode" just to function before the stent was placed. That meant naturally occurring steroids were constantly being released into my bloodstream, and steroids make a diabetic's glucose level go up, UP, UP! So once I'd shared my hypothesis with him, he agreed that he might very well be responsible for my blood sugars improving.

Mind you, it was a marginal improvement, but an improvement nonetheless.

For the record, I tried. I did. I bought decaffeinated coffee to get my day started. I'm not affected by caffeine for some bizarre reason. In terms of alertness, that is. If anything, I typically experience caffeine crashes after drinking a cup of coffee. After years of drinking regular coffee, decaf tasted... off. Only one brand ever got it right, and I can't find it for the life of me anymore. 

~ shakes fist impotently at the sky ~ Damn you, Maxwell House!

So I, ummm... I gave up. I have my ONE cup of java in the morning, and that's it. Just one. And one, is seems, is about all I can handle at this point. Because when I drink my singular cup of joe, things inside my aging body go absolutely goofy. 

Let me be clear. The only carbohydrates in my coffee come from my sugar free, French vanilla creamer. Somewhere between 8 to 10 grams of carbs total, which on a diabetic exchange diet isn't even the equivalent of one piece of bread. (15 grams = one bread.) The artificial sweetener I use adds zero carbs. 

I believe I've discussed it before, but I'll review how I decide how much insulin to take. I check to see what my glucose IS, calculate how many "breads" I'll be having with the coming meal, and then add enough for what I assume my glucose WILL BE. Because I'm insulin resistant, my doses are high. VERY high. In fact, when I tell hospital staff how much insulin I would normally take, they silently assume I'm trying to get them to kill me and go with their preset standards. They come in and tell me they're going to give me a "very high dose of 11 units," and I'll reply, "Oh, that is adorable." Later, when my blood sugar is checked and it comes back at 400 or more, they start taking me seriously. If my blood sugar is normal, between 80 and 110, I'll take 28 units of Humalog if there are three "breads" in my coming meal.

But in the morning, if my glucose is normal, (which is rare*), and I'm going to have my coffee, and ONLY my coffee - no other food of any kind - I take... Brace yourselves... 

...

...

...

...

...

48 UNITS OF HUMALOG!

That's probably enough to kill a bear, if not an elephant. This is because the coffee puts a lot of stress on my cardiovascular system. Has this been confirmed medically? Nope. But I'm not eating anything else in the morning, my creamer is sugar free, (but still has carbs, which are accounted for), and I use artificial sweetener. So if someone else can come up with a better theory, I'm all ears. The closest thing to "proof" are my sparkling lunch readings, which DO come closer to that perfect range.

*About my fasting blood sugars rarely being normal... This is a whole different issue about balancing my insulin doses more carefully at night, which I'll try to get into in the near future.

I'm 55. I have no family. My friends are all distant. I'm both alone and lonely. So I'm going to break some of the rules every now and again, especially if breaking them means I get a little enjoyment out of life.

The proper summoning configuration

to get me out of bed in the morning.

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?

Showing a Little Leg

That's right, mute members of my malcontent musings, it's time for a little alliteration and to look in on my leg wound. Because I know all of you secretly thrill to images of open flesh, right? Right.

For the record, or so those that are responsible for the record have told me, podiatrists are responsible for everything below the knees. Since this is the case, I'm going to start qualifying leg wounds like the one I'm treating as "Wound Care for Feet" in the "labels section."

That said, I'll post all of the pictures again, finishing with the one I took this morning.

The initial wound.

After 10 days of wound care.

After 20 days of wound care.

The progress is far more obvious than the previous update. The single wound has been split in two by the bridge of new skin. 

Something I haven't brought up is a diabetic's inability to heal swiftly. Microvascular damage prevents blood flow to injuries, slowing the healing process. That's why it's imperative to engage in proper wound care. So, again...

1. Keep the wound clean. Gently wash with soap and water and PAD the wound dry with sterile gauze*. Unless there's dirt or other foreign matter in the wound, do not scrub!
2. Disinfect with betadine or iodine. Either will help eliminate microbial growth that could lead to infection.
3. Coat the wound with antibiotic ointment. This step is optional, but I recommend it to prevent scabs from sticking to anything you use to cover the wound. That means the next step is...
4. Cover the wound. Depending on the wound's size, use gauze or Band-Aids. I prefer not to use anything that will stick to my skin, since is was just such an adhesive that made the original wound larger. 
5. Stay alert for signs of infection. That includes increased pain, pus, the area around the wound becoming hot to the touch, the area around the wound becoming particularly red and angry, a foul odor coming from the wound or gauze during dressing changes, and/or fever.
6. Keep the wound covered. Studies have show that "allowing a wound to air out to dry" doesn't help the healing process. Keeping it covered and protected does.

If you noticed the asterisk in step one, sterile gauze can be expensive. If I don't have any on hand, I'll cut corners, but do so very carefully. You see, I keep 91% isopropyl alcohol in a small spray bottle on hand. I'll take a paper towel, spray it a few times, getting it moist, but not soaking it. Wave it a bit so it dries, then use it to pad the wound. Do not use isopropyl alcohol on an open wound! It will kill healthy cells that are trying to heal you. And it'll STING!!! 

That's it for today. My right thumb is screaming at me, and I didn't even use it while typing this! So until my next action-packed entry, be well!

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! 💖

Every Post Could Be My Last

Yeah, I know I've been complaining lately about the lack of interaction with my real or imagined readers. But this isn't about that. No, really. No, wait! Don't leave!

You left, didn't you? Fine. Then you don't get to read my very serious post about very serious things.

Waiting in the wings are posts about heart disease and alcohol, but I thought I should solidify my reality to bring absolute clarity about my current health. I've been truthful with all of you. My everything is broken to some extent. It's all being monitored by doctors and controlled with medications. Alas, that doesn't discount the idea that I could quite suddenly kick the bucket.

"Gee, Rob. You're such an incredible ball of happiness today. What's got you in such a good mood?" 

Easy there, Captain Sarcasm. But I'll tell you. I recently watched a video from the Weird History channel about 2020, and it seemed like EVERYONE died. Not from COVID. These people just died. Some of them not all that much older than me. When you consider that I'm a 55-year-old man living in a body that functions as well as an 80-year-old man, the risks become apparent.

There's a little more than that. It was a discussion I had with a podiatrist some years ago. (I think I've already mentioned this, but if you think I'm gonna reread my every post to find it, you got another think comin'.) I mentioned that diabetics tend to live an average of 10 years after a major amputation. After a thoughtful pause, he agreed with me. October will officially make it four years since my left foot had to be removed. So... Maybe six years left?

I don't know. My current PCP believes I can beat the odds because I'm taking much better care of myself than other late-stage diabetics.

But he's also aware of something relatively new to my list of complications. It's a fun little problem that comes with advanced diabetic neuropathy. I don't always feel my blood sugar dropping. I have gone as low as 55 without feeling any symptoms. Remember my tale about passing out that one and only time? Imagine my glucose already being so low when I finally notice it that stand to get something to raise it, but by that point I don't have enough sugar to continue functioning. Down I go. "Rob's face, Floor. Floor, this is Rob's face." I suppose I could try to get a service dog that can sense a diabetic's glucose levels, but I don't have the maximum price of $25,000 lying around. (Besides, I don't have the means to care for a dog.)

I have a few tales of low blood sugar, but one that stands out is when I was being hospitalized and woke in the middle of the night. Rather than ring for my nurse and have her eventually come to my room, I sought her out. We went straight to the nurse's station, where she checked my glucose. I was a whopping 34. She saw the result, looked up and me, and asked, "How are you still standing?" 

That was 22 years ago. Things change in an aging body, and not usually for the better.

A fact that bears repeating is that the brain needs glucose to function just as much as it needs oxygen. I live alone. If I pass out from hypoglycemia, it's officially coma time. Without fuel to keep everything inside me fueled, coma time would become... Well, dead time.

Forgive me a moment as I turn into something of a drama queen (king?). After only four people responded to a birthday request, I got depressed and decided to run an experiment. I temporarily suspended my Facebook account (where us old fogies still hang out) and waited. I stayed off for longer that 30 days so they wouldn't think I was merely in Facebook jail. Care to guess how many people called, messaged, or came by to check on me? Zero. Some of them noticed my absence, but didn't do anything about it. They just... let it go.

My FRIENDS made that choice.

Y'know what taxes my beleaguered psyche about that? Some of my friends love me, and the rest seem to at least like me. They laugh at my comedic posts and comments. If I write something heartfelt, they respond with the "care" or "sad" reactions. So with my silence, was I missed or not?! I feel like I had become Schrödinger's human. (Okay, what is that? Sometimes it happens when I c-n-p, and sometimes it just happens because. That's it. Just because.)

I'm not harping on that. I'm simply pointing it out. And, hey! If I DO die and go unnoticed for a while, I should be lighter to carry out of my apartment, what with decomposition removing a little of that unwanted weight.

Silver linings, people. 😉

Okay. News shared. Drama played out. Let's all take a deep breath and appreciate this post's blatant lie about who my wife is this time.

This is Monica Barbaro,

AKA "Phoenix" in

Top Gun: Maverick.

Yeesh. Yet another "wife" who's young enough to be my daughter. I should be ashamed of myself... but for the sake of the silliness of it all, I'm not. 😛

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. 🙂)