Sunday, 21 August 2016

Nerve Damage Complications From Diabetes Mustn't Be Underestimated

Today's post from (see link below) is the story of a diabetes patient living with neuropathy (amongst other things) who is forced to lose a toe and it offers a salutary lesson in the consequences of certain life choices. The important thing is to avoid becoming diabetic in the first place but hey, that's easier said than done. Can't preach here but sometimes reading someone else's account of their medical history can shake you up a little and maybe persuade you to change a few things to make your health picture a little less alarming. The risk of losing parts of your feet due to neuropathic complications is all too real for some patients.

This little piggy
Roger212 Aug 3rd 2016

Diabetes Complications and other Conditions

I have never been a 'good' diabetic. Compliance with rules is just not in my nature. I was diagnosed in 1967, at the age of 18, after I had gone into hospital
for a relatively minor surgery. Two weeks after that diagnosis, I was
launched back into the world, scared and not completely sure of what
came next. The nurses had taught me all about doing injections, and I
had a shiny glass syringe and a box of one-time use needles. I also
had a diet booklet from the dietician, prescribing a 2,000 calorie
diet. Two thousand calories? Come on, I was a teenager. I ate 2,000
calories for breakfast.

Diabetes ended my plans for a military career, but I had finishing high school and getting into University to worry about, so I took my 16 units of Lente
insulin daily, avoided sweets and did pretty much what I wanted. In
those days we couldn't test for blood sugar, so we had to test for
urine sugar until the 90s. My tests always showed 4% or higher, the
highest a test could go. I saw my GPs mostly, although once in a
while they would send me to hospital for “stabilization.”

In my thirties I went through a period of heavy drinking. I don't know if it's coincidence, but it was at this time I lost the sight in my left eye. I went back
and forth between the right eye and the left eye for a few years, but
was blind in both eyes for only a week. I recovered most of my
eyesight through laser and a couple of actual eye surgeries, and a
very, very good ophthalmologist. This cost me a job, as my company
decided “your position is no longer required.” Yeah.

Skip ahead a few years, and I'm in my fifties, now equipped with human insulin and a blood glucose meter. My blood glucose management is better, but still not
good. In around 2005, I had my first foot infection. It involved my
left big toe and first toe, and they turned black. Due to the good
offices of the surgeon my GP sent me to, These toes recovered nicely,
and in six months or so looked as if they had never had a problem.

For several years I had recurring infections in toes on both feet. The usual course of events was that my toe or toes would turn black, and after antibiotics and frequent dressing changes they would slowly recover. I quickly knew
all of the staff at the wound clinic by their first names, and they
treated me wonderfully, and still do today.

So, at this point I had racked up neuropathy, nephropathy, retinopathy, cataracts, heart disease, a strange condition that gives me vertical double vision, mild liver and kidney problems, and arthritis. That last one may not
be due to diabetes, as it runs in my family. Oh! Oddly enough, I
suffer from depression, although I am medicated and able to hold it
at bay, but I don't smile much.

My last toe problem occurred in 2013 on a trip, at Heathrow airport. I was travelling with my daughter who was on a business trip to Paris and London. She noticed blood on the floor when I came out of the bathroom in the
morning. My right big toenail had become detached, and we dealt with
it with some bandaids my daughter had, and bought some supplies when
we got to Paris. I limped through the rest of the trip, and got back
to the wound clinic, where the doctor saved me again.
I continued to go to the wound clinic monthly for medical pedicures. They handed that job off to a podiatrist who shares office space with the clinic. At one of these pedicures, in March this year, the podiatrist discovered a
sore on the end of my middle right toe.

So now it was back to the wound clinic for antibiotics and dressing changes. After two months, I brought up the possibility of an amputation, as we seemed to be getting nowhere with the toe. Furthermore, I was having considerable
pain from the toe. The doctor wanted to wait awhile, but in June
X-rays revealed that the bones in the toe were fully infected. So we
agreed on an amputation, and set the following Wednesday, June 22, as
the date.

I had thought the process of amputation would require some fanfare – a hospital stay, hospital food, pretty nurses, all that. However, it was done in the
clinic, on the same cot I lie on for dressing changes or pedicures.
The doctor took off the dressing, wiped the toe down and gave me some
local anaesthetic. Then, while we chatted back and forth, he
cheerfully removed the toe. No pain, no fuss. I saw the toe go into a
specimen jar, and called out, “Wait, wait! I've changed my mind!”

The doctor said, “Ya want me to put it back? Too late!” and we all had a laugh. They are used to me at the clinic. In a matter of minutes the wound was
bandaged, and I walked out of the clinic with a note to come back at
7:30 the following morning. I had walked into the clinic at 7:25, and
walked out at 7:50, less one toe, but the pain from the toe was gone,
and stayed gone.

Along with my family and friends we came up with a bunch of jokes about only being able to count to 19, having difficulty playing “This little piggy.” After
all, do you drop the one that had roast beef, or the one that had
none, or go to the fourth toe and say “This little piggy had tofu,”
because then the next little piggy wouldn't want any, and could go
“Wee, wee...” oh, never mind!

All jokes aside, it isn't easy to give up a toe. It seems like a small thing, and I recognized the necessity, but when it got down to the crunch, I felt saddened. I
have known for fifty years that something like this could happen.
Thank God that I have made it this far without going blind, as has
happened to people I know. I also know people who have lost legs.
Some of those have subsequently lost their lives, so I know it could
be worse, and could get worse. But as I mentioned, I suffer from
depression, and am beginning to do a lot of sitting around with time
to think.

The wound appears to be healing well, and it seems by mid August it will be healed. This
should allow me to return to my activities such as woodwork,
swimming, walking and maybe even riding my bicycle, but two weeks ago
the doctor showed me X-rays that show the second toe is infected in
the bone, and therefore must go, too. So, the piggy that stayed at
home is to be evicted.

This did not improve my mood. It puts my recovery off until late September, and cancels any thoughts I may have had of doing much this summer. I spent a week with my daughter recently, and had to do my own dressing changes,
which is something I am unwilling to repeat. I should be able to
dance at my daughter's wedding on October 1 if nothing else goes
awry. I thought at one time that removing the toe would be the end of
the problem for now, but of course that is not true. I now have to
deal with the possibility of losing half a foot, and after that, half
my lower leg.

I try not to sit around dwelling on the problem or its infinite possibilities. There are things I can do, and I do them. I am trying to be careful about my
bgs, and waiting for the day when the doctor says, “There, Roger!
You're all healed. You don't have to come back here any more.” That
will be the best present I could have.

I said at the outset that I have not been a 'good' diabetic, but I'm still here after 50 years.

I know I have done things wrong during the course of this whole
thing, and I don't need to hear about it. The thing a diabetic
doesn't need to hear when faced with complications is, “You could
have prevented this if....” This is just my experience of losing a
toe. Whether you see it as inspiration or cautionary tale is up to
you. I hope you have gained something from it.


Just before submitting this, I saw the doctor at the clinic, and he thinks my second toe may get better, so we are holding off removing it until it gets a chance to improve. So, the second piggy has a stay of execution. We'll wait
and see.

Roger N. Tulk (Roger212)

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