I have not abandoned this blog, despite the lack of a new post since April. (Forthcoming case in point, no sooner did I write that one line on June 4th when I was distracted away and unable to get back.)
Now it’s July 6th and I believe I can finish a hasty missive.
2013 has left me with an overwhelming sense of loss. On top of reduced capabilities and an attrition of friends, over the time since the eye problems began, I started the year with poor feelings for having sold my car. I can accept the inability to drive more than no longer owning a vehicle.
As the year progressed, I had an eye procedure that brought complication and less result than anyone had hoped. My father passed away, I noticed that the Crow boot-bound leg is losing muscle mass and even routine things took more effort. Even further reduced exertion was more than I found I could handle. I’ve had to give up more, especially when "over" exertion inflamed the tendon in my leg, which re-triggered the Charcot Foot inflammation and ended up ulcerating the ankle. The hole was larger than a silver dollar. More than three months later, it’s about the size of a penny or nickel.
I suffered the worsened by moving prized possessions to a venue for their sale. Despite the pride in ownership, this stuff is heavy and bulky and useless to a blind guy. Removal became critical because the fact that my apartment–in a house I own–is no longer livable for me, even before the reduced eyesight and worsened leg. There’s 34 steps between the street and my apartment; 48 between the street and my bedroom. It’s hard enough getting in the house empty handed. Groceries are outright burdensome.
The eyesight, particularly effects of and adjustment to changes in light, is worse. This limits everything, including functional computer time. Work on fiction projects has stagnated as much as the blog while I try to close out responsibilities and roll with the changes.
Things are looking less bleak. My guardian angels may be masochists, but they are on the job!
Showing posts with label Charcot Foot. Show all posts
Showing posts with label Charcot Foot. Show all posts
Saturday, July 6, 2013
Friday, April 26, 2013
Circling Charcot
My resurgence of Charcot "Sharko" Foot makes it a good time to go over the condition, especially as one of the biggest threats of the condition is that it is rare enough that doctors can easily make it worse. To the cost of the patient’s limb.
Charcot Foot these days is almost an exclusive diabetic condition characterized by sudden and often "inexplicable" swelling of the foot. The foot will often "run a fever" and can be seven degrees Celsius warmer than the non-afflicted foot. The condition is most often painless to the patient.
Usually, the Charcot Foot is triggered by a break or fracture among the bones of the foot. With reduced circulation and/or nerve damage, the diabetic does not feel the break and continues to use the foot as normal. The swelling is the body’s way of protecting itself.
The unintentional risk posed by doctors is that the attending physician will not recognize or know of the condition. Often, the doctor will probe the swelling to test for bacterial or viral infection within the foot. In doing so, the doctor may introduce surface skin bacteria inside the foot and cause a sever infection that can jeopardize the limb. The patient should neither allow biopsy nor any type of mechanical reduction of the swelling. About half the patients who allow those thing quickly lose the foot.
Treatment for the Charcot relies on treatment for the underlying cause. X-rays and MRI’s are often necessary to determine the damage location and extent. Staying off the afflicted foot as much as possible will be necessary. The bones must heal properly. If they do not, they can separate further, mal-forming the foot permanently and risk ulceration of the foot. To be bluntly graphic, ulceration of the foot is when the bones poke through the skin from the inside out. The risk of infection during an ulceration is high, and the diabetic patient may not be able to feel it happening.
As usual with me, everything was slightly unusual. I developed Charcot Foot not because of a broken bone, but by tendon damage in my toe self inflicted by a hard kick. I had an inept foot doctor who prematurely declared the Charcot had passed Phase One and did not take into consideration that I was on eye-dropped prednisone for an eye surgery. The Charcot Foot renewed with a vengeance, and the swelling further reduced circulation. With further impeded circulation, nutrients including high levels of calcium and deficient Vitamin D could not reach the center of the ankle. The central bones collapsed, permanent damage that put me in a Crow Boot.
Overuse re-triggered the Charcot Foot recently by re-inflaming the tendon. When the foot swelled, the Crow Boot no longer fit correctly and the ankle bones that are twisted and misshapen ulcerated through the side of the ankle.
The tendon will ever be likely to re-inflame while a broken bone would likely have mended. The crushed ankle cannot mend. I have to be diligent, and my situation of not being able to feel much pain in the ankle combined with an inability to see things wrong with the foot makes that even more of an effort.
Charcot Foot these days is almost an exclusive diabetic condition characterized by sudden and often "inexplicable" swelling of the foot. The foot will often "run a fever" and can be seven degrees Celsius warmer than the non-afflicted foot. The condition is most often painless to the patient.
Usually, the Charcot Foot is triggered by a break or fracture among the bones of the foot. With reduced circulation and/or nerve damage, the diabetic does not feel the break and continues to use the foot as normal. The swelling is the body’s way of protecting itself.
The unintentional risk posed by doctors is that the attending physician will not recognize or know of the condition. Often, the doctor will probe the swelling to test for bacterial or viral infection within the foot. In doing so, the doctor may introduce surface skin bacteria inside the foot and cause a sever infection that can jeopardize the limb. The patient should neither allow biopsy nor any type of mechanical reduction of the swelling. About half the patients who allow those thing quickly lose the foot.
Treatment for the Charcot relies on treatment for the underlying cause. X-rays and MRI’s are often necessary to determine the damage location and extent. Staying off the afflicted foot as much as possible will be necessary. The bones must heal properly. If they do not, they can separate further, mal-forming the foot permanently and risk ulceration of the foot. To be bluntly graphic, ulceration of the foot is when the bones poke through the skin from the inside out. The risk of infection during an ulceration is high, and the diabetic patient may not be able to feel it happening.
As usual with me, everything was slightly unusual. I developed Charcot Foot not because of a broken bone, but by tendon damage in my toe self inflicted by a hard kick. I had an inept foot doctor who prematurely declared the Charcot had passed Phase One and did not take into consideration that I was on eye-dropped prednisone for an eye surgery. The Charcot Foot renewed with a vengeance, and the swelling further reduced circulation. With further impeded circulation, nutrients including high levels of calcium and deficient Vitamin D could not reach the center of the ankle. The central bones collapsed, permanent damage that put me in a Crow Boot.
Overuse re-triggered the Charcot Foot recently by re-inflaming the tendon. When the foot swelled, the Crow Boot no longer fit correctly and the ankle bones that are twisted and misshapen ulcerated through the side of the ankle.
The tendon will ever be likely to re-inflame while a broken bone would likely have mended. The crushed ankle cannot mend. I have to be diligent, and my situation of not being able to feel much pain in the ankle combined with an inability to see things wrong with the foot makes that even more of an effort.
Wednesday, April 24, 2013
Insensitive
Long story short on the latest malady:
I over-exerted from the third week of March through the first week of April, with a steady increase in activity. This caused no immediate strain, but inflamed the bad tendon, which inflamed the Charcot Foot, which caused the ulceration of my ankle. The open wound is typically encased in a Crow Boot, which is a tight, foam-lined brace that supports the permanently I have to wear the Crow Boot at all times or risk further ankle collapse whenever I put weight on the right leg. The Crow Boot can be very warm on the leg, and a symptom of Charcot Foot itself is temperature of the foot that can be seven degrees Celsius above the rest of the body.
This forms the ideal conditions for bacterial growth, dark and warm and moist. The problem getting so bad so fast is not a sign that I am a bad diabetic who does not take care of himself. It is a matter that I am a diabetic with nerve damage who could not feel the break in the skin on the foot. I am a blind diabetic who could not see the break in the foot, or blood on a dark sock.
Two things made me aware of the problem. The first was a lingering smell. I wondered what the bad smell was in the kitchen. I noticed it in another room. I thought the cat box in the bathroom had a funky odor. When I went to bed that night, the smell from the removed boot was overpowering. I happened to notice that the sock was wet, but not in a uniformly sweaty way. I touched what is normally a rough, dry area of skin and squished my finger in a wet hole.
I called a tenant who helps me out a lot. He came over and we cleaned things up. He found my emergency pack of antibiotics and I started those.
By specific criteria, he agreed with my decision not to go to an emergency room that night, but to get in contact with my regular foot doctor in the morning. This decision was not for financial reasons, but logistical ones. The truth is, Charcot Foot is not all that common and many doctors will not recognize it. Many, in the course of good and reasonable treatment, will do things that will increase the risk of Charcot Foot leading to amputation. I felt safer going to my doc–Thomas Mancini of North Providence–rather than to someone who I could only hope would not make things worse. I’ve been there and done that.
Dr. Mancini saw me that day. He cut away some dead tissue and was surprised by the amount of bleeding. Nerve damage is not the same thing as circulation problems. He prescribed Augmentin, a powerful antibiotic. I am making a concentrated effort to stay off the leg and keep the boot off when I can so the wound can breathe. I did catch the problem soon enough that the infection had not reached bone or flooded my system. The antibiotics knock me out a bit, but do not bother my stomach. I will be staying on them (and off the leg as much as possible) until the wound is healed up.
This may sound odd from a blind limpy guy, but I am lucky.
I over-exerted from the third week of March through the first week of April, with a steady increase in activity. This caused no immediate strain, but inflamed the bad tendon, which inflamed the Charcot Foot, which caused the ulceration of my ankle. The open wound is typically encased in a Crow Boot, which is a tight, foam-lined brace that supports the permanently I have to wear the Crow Boot at all times or risk further ankle collapse whenever I put weight on the right leg. The Crow Boot can be very warm on the leg, and a symptom of Charcot Foot itself is temperature of the foot that can be seven degrees Celsius above the rest of the body.
This forms the ideal conditions for bacterial growth, dark and warm and moist. The problem getting so bad so fast is not a sign that I am a bad diabetic who does not take care of himself. It is a matter that I am a diabetic with nerve damage who could not feel the break in the skin on the foot. I am a blind diabetic who could not see the break in the foot, or blood on a dark sock.
Two things made me aware of the problem. The first was a lingering smell. I wondered what the bad smell was in the kitchen. I noticed it in another room. I thought the cat box in the bathroom had a funky odor. When I went to bed that night, the smell from the removed boot was overpowering. I happened to notice that the sock was wet, but not in a uniformly sweaty way. I touched what is normally a rough, dry area of skin and squished my finger in a wet hole.
I called a tenant who helps me out a lot. He came over and we cleaned things up. He found my emergency pack of antibiotics and I started those.
By specific criteria, he agreed with my decision not to go to an emergency room that night, but to get in contact with my regular foot doctor in the morning. This decision was not for financial reasons, but logistical ones. The truth is, Charcot Foot is not all that common and many doctors will not recognize it. Many, in the course of good and reasonable treatment, will do things that will increase the risk of Charcot Foot leading to amputation. I felt safer going to my doc–Thomas Mancini of North Providence–rather than to someone who I could only hope would not make things worse. I’ve been there and done that.
Dr. Mancini saw me that day. He cut away some dead tissue and was surprised by the amount of bleeding. Nerve damage is not the same thing as circulation problems. He prescribed Augmentin, a powerful antibiotic. I am making a concentrated effort to stay off the leg and keep the boot off when I can so the wound can breathe. I did catch the problem soon enough that the infection had not reached bone or flooded my system. The antibiotics knock me out a bit, but do not bother my stomach. I will be staying on them (and off the leg as much as possible) until the wound is healed up.
This may sound odd from a blind limpy guy, but I am lucky.
Monday, April 22, 2013
Life and Limb
Yes, the blog’s been neglected this month. So has everything else. The new hole in my ankle is my excuse and my valid reason.
The Charcot Foot has relapsed with new complications. People who have read the older posts about the Charcot development may remember that I did not get Charcot Foot in a normal way. It is an esoteric diabetic thing, but normally stems from unfelt breaks or fractures in the foot. Mine resulted from tendon damage. During a "second" stage of Phase One, my circulation reduced During that time when nutrients could not find effective delivery to my swollen foot, the central bones of my ankle collapsed and a minor toe problem gangrened inside of three days. Luckily, somehow I did not have any part of the foot or toe amputated, although some meat was shaved off of the big toe. I’ve been in a Crow Boot since to reinforce the structural weakness of my ankle.
I am now a patient of podiatrist Thomas Mancini, who has offices in North Providence and East Greenwich Rhode Island. Doctor Mancini did great by me in every way. Instead of rehashing the bad things involved in last year’s mess, I’ll refer newer readers to the label for "Sturdy Hospital" and an old post titled "Doctor Dumbass."
So what went wrong this time? I over-exerted. I had to be a little more active with some things through the final weeks of March. That bothered the leg tendon in the thigh somewhat. Just having to walk to the adjoining building from my apartment is some 75 stairs each way. Having to make that walk so many times took more out of me than "it should."
April started with a project of moving things out of the house and setting up for sales in a booth at an antique co op. I arranged to hire an old friend ahead of time, a big brawny guy who can handle moving 40 boxes better than a limpy gimpy blind guy can. The fault in that plan was in hiring someone without a job. This friend has not outgrown his lazy streak since we’d had more exposure to each other. He called on the appointed day with supposed willingness but plenty of work-aversion ideas and theories. I went to the back up plans, which required more direct effort of me and did not get the entire project done in one day. It’s still not finished.
The efforts inflamed the tendon from toe to groin. This re-triggered the Charcot Foot. The foot swelled. Being trapped in a fitted brace that was now too tight, the collapsed ankle bone ulcerated the inside of the ankle against the boot. The Crow Boot is tight and warm, an ideal environment for bacterial growth.
My roommate was away that week. I can neither see nor really feel a problem on that lower leg. I realized it was infected by the smell.
Infection on that leg is literal risk to life and limb. Unchecked, an infection can flood my entire body pretty quickly, or it can root into local bones and necessitate removal of those bones and the part of the leg they form.
The Charcot Foot has relapsed with new complications. People who have read the older posts about the Charcot development may remember that I did not get Charcot Foot in a normal way. It is an esoteric diabetic thing, but normally stems from unfelt breaks or fractures in the foot. Mine resulted from tendon damage. During a "second" stage of Phase One, my circulation reduced During that time when nutrients could not find effective delivery to my swollen foot, the central bones of my ankle collapsed and a minor toe problem gangrened inside of three days. Luckily, somehow I did not have any part of the foot or toe amputated, although some meat was shaved off of the big toe. I’ve been in a Crow Boot since to reinforce the structural weakness of my ankle.
I am now a patient of podiatrist Thomas Mancini, who has offices in North Providence and East Greenwich Rhode Island. Doctor Mancini did great by me in every way. Instead of rehashing the bad things involved in last year’s mess, I’ll refer newer readers to the label for "Sturdy Hospital" and an old post titled "Doctor Dumbass."
So what went wrong this time? I over-exerted. I had to be a little more active with some things through the final weeks of March. That bothered the leg tendon in the thigh somewhat. Just having to walk to the adjoining building from my apartment is some 75 stairs each way. Having to make that walk so many times took more out of me than "it should."
April started with a project of moving things out of the house and setting up for sales in a booth at an antique co op. I arranged to hire an old friend ahead of time, a big brawny guy who can handle moving 40 boxes better than a limpy gimpy blind guy can. The fault in that plan was in hiring someone without a job. This friend has not outgrown his lazy streak since we’d had more exposure to each other. He called on the appointed day with supposed willingness but plenty of work-aversion ideas and theories. I went to the back up plans, which required more direct effort of me and did not get the entire project done in one day. It’s still not finished.
The efforts inflamed the tendon from toe to groin. This re-triggered the Charcot Foot. The foot swelled. Being trapped in a fitted brace that was now too tight, the collapsed ankle bone ulcerated the inside of the ankle against the boot. The Crow Boot is tight and warm, an ideal environment for bacterial growth.
My roommate was away that week. I can neither see nor really feel a problem on that lower leg. I realized it was infected by the smell.
Infection on that leg is literal risk to life and limb. Unchecked, an infection can flood my entire body pretty quickly, or it can root into local bones and necessitate removal of those bones and the part of the leg they form.
Friday, March 1, 2013
Charcot Revisited
The Charcot "sharko" Foot seems settled and healed. Perhaps I should do another visit with the good foot doctor, Thomas Mancini, before declaring that, bur I say so from observation of my own body.
The biggest "wild card" advantage I had during the Charcot cycle actually came from the retina reattachment. I was dropping prednisone into my eye, which regulated and reduced the swelling.
On the eye doctor’s advice, I ceased the prednisone. I did this with reluctance; when I tried getting off the prednisone in spring of 2012, the Charcot Foot, then erroneously declared "past Phase One according to Doctor Dumbass, flared worse than before.
This time, judging by the lack of a flare up, Phase One was truly over. The leg has not reswelled with discontinuation of the eye drop prednisone.
I had discussed the side effects of the prednisone with my eye doctor on previous occasions. She wrote off the stomach problems as a probable diabetic thing, perhaps bad kidneys. Maybe her opinion changed the morning she treated the post-victrectomy pressure build up. That was a bad morning altogether, even before she stuck a needle in my eye. Perhaps watching me retch acidic bile convinced her that the prednisone was having the stomach acid overproduction. Who knows? Maybe my puking in her trash barrel was the real reason she stuck a needle in my eye.
With the prior massive swelling of the left leg below the knee last fall, my already hindered diabetic circulation was further impaired. This had led to the gangrene infection on the toe, the problem that sent me to Sturdy Hospital in May. That all recovered nicely, without amputation but with a loss of some fleshy tissue from the big toe. More devastating, the swelling reduced circulation to the structure of the foot. I did not particularly stay off the foot, particularly with Dr. Dumbass telling me all was well. During this time, the bones could not get the nutrients they needed. Those nutrients were there; the semi-regular blood tests always show my calcium on the high end of the scale. While swelled, the center bone of the ankle and the inner portion of the hell bone weakened, rolled and collapsed. My right leg shortened about an inch, and it will never be safe for me to put weight directly on that ankle. The crow boot I wear everywhere except to bed and in the shower keeps the weight off and protects the leg with immobilization. I don’t complain about the Crow Boot. Without it, I would rely on crutches, and there’s not as much I could do with my hands otherwise occupied. The immobilization by the Crow Boot has had its own side effect. My calf muscle has diminished, to the point that it is noticeably smaller than the left calf. The Crow Boot is not a temporary cast or brace, but a permanent fixture.
It is what it is. I am accepting about it, even when I freely acknowledge that the combination of bad leg and blind eyes is a particularly difficult combination.
Difficult, but not insurmountable.
The biggest "wild card" advantage I had during the Charcot cycle actually came from the retina reattachment. I was dropping prednisone into my eye, which regulated and reduced the swelling.
On the eye doctor’s advice, I ceased the prednisone. I did this with reluctance; when I tried getting off the prednisone in spring of 2012, the Charcot Foot, then erroneously declared "past Phase One according to Doctor Dumbass, flared worse than before.
This time, judging by the lack of a flare up, Phase One was truly over. The leg has not reswelled with discontinuation of the eye drop prednisone.
I had discussed the side effects of the prednisone with my eye doctor on previous occasions. She wrote off the stomach problems as a probable diabetic thing, perhaps bad kidneys. Maybe her opinion changed the morning she treated the post-victrectomy pressure build up. That was a bad morning altogether, even before she stuck a needle in my eye. Perhaps watching me retch acidic bile convinced her that the prednisone was having the stomach acid overproduction. Who knows? Maybe my puking in her trash barrel was the real reason she stuck a needle in my eye.
With the prior massive swelling of the left leg below the knee last fall, my already hindered diabetic circulation was further impaired. This had led to the gangrene infection on the toe, the problem that sent me to Sturdy Hospital in May. That all recovered nicely, without amputation but with a loss of some fleshy tissue from the big toe. More devastating, the swelling reduced circulation to the structure of the foot. I did not particularly stay off the foot, particularly with Dr. Dumbass telling me all was well. During this time, the bones could not get the nutrients they needed. Those nutrients were there; the semi-regular blood tests always show my calcium on the high end of the scale. While swelled, the center bone of the ankle and the inner portion of the hell bone weakened, rolled and collapsed. My right leg shortened about an inch, and it will never be safe for me to put weight directly on that ankle. The crow boot I wear everywhere except to bed and in the shower keeps the weight off and protects the leg with immobilization. I don’t complain about the Crow Boot. Without it, I would rely on crutches, and there’s not as much I could do with my hands otherwise occupied. The immobilization by the Crow Boot has had its own side effect. My calf muscle has diminished, to the point that it is noticeably smaller than the left calf. The Crow Boot is not a temporary cast or brace, but a permanent fixture.
It is what it is. I am accepting about it, even when I freely acknowledge that the combination of bad leg and blind eyes is a particularly difficult combination.
Difficult, but not insurmountable.
Sunday, February 17, 2013
Bowling Blind
I am still bowling. I’m blind and need to wear the orthopedic Crow Boot at all times, but I’m still out there trying. The Crow Boot is allowed, but I need to cover it to make sure that I do not introduce foreign objects to the floor as these could pose hazards to others or damage the lanes. I wrap the Crow Boot in a pillow case and secure it with a couple bungee cords. I chose dark pillow cases so I would pick up evidence if anyone was illegally using powder on their shoes.
Bowling is not easy. I’m contending with not being able to see the pins. My teammates tell me what pins remain standing after the first ball. I line myself up by the contrast between lane and gutters and hope for the best.
The Crow Boot is not always stable. The pillowcase can puff out and pose a tripping hazard to myself. My foot does not always feel stable or level inside the boot. I can be misaligned to the lanes and not fully realize it.
Sugar fluctuations plague me even more often. My sugar is inclined to fall suddenly with the onset of activity, and the bowling is the most exerting thing I do in life. Actually, it’s one of the few things I do.
My fourth barrier to success this season was my choice of purchase place for my new ball. I changed only because my blue ball blended in with all the other dark balls on the return rack. I bought a cow print ball just so I could see easily which one was mine. I could have–and should have–gone through the pro shop at the lanes, but I wanted to buy local to me and not in what I figured was a captured audience. I went to Bowler’s Edge in Pawtucket, essentially in my neighborhood. That was a mistake. He ordered the ball and said it should be in next week. He forgot to mention he would be on vacation for two weeks. When, a month later, the ball came in, he ignored my mention of being blind and needing to throw a straight ball and he drilled the finger holes for a hook ball. I certainly won’t be doing business with him again nor would I recommend him to anyone.
I started off lucky this year, but all the various handicaps with me and the ball before it was filled and redrilled played havoc. I was trying to learn to bowl with the Crow Boot, increasing visual impairment and a ball most definitely not reacting to my typical throw. I had plenty of nights where breaking 200 was an impossibility. That’s a 200 total between three games I could not do. My high game was a 157. I had to take time off from both leagues post victrectomy, and seem to be going a little stronger now.
I need of course to acknowledge my teammates in both leagues. Almost all are new teammates this year, and have been accommodating to my gimpiness. I am in less competitive leagues, and while I tremendously miss some prior years’ teammates, I still feel lucky to be bowling with such understanding people.
Bowling is not easy. I’m contending with not being able to see the pins. My teammates tell me what pins remain standing after the first ball. I line myself up by the contrast between lane and gutters and hope for the best.
The Crow Boot is not always stable. The pillowcase can puff out and pose a tripping hazard to myself. My foot does not always feel stable or level inside the boot. I can be misaligned to the lanes and not fully realize it.
Sugar fluctuations plague me even more often. My sugar is inclined to fall suddenly with the onset of activity, and the bowling is the most exerting thing I do in life. Actually, it’s one of the few things I do.
My fourth barrier to success this season was my choice of purchase place for my new ball. I changed only because my blue ball blended in with all the other dark balls on the return rack. I bought a cow print ball just so I could see easily which one was mine. I could have–and should have–gone through the pro shop at the lanes, but I wanted to buy local to me and not in what I figured was a captured audience. I went to Bowler’s Edge in Pawtucket, essentially in my neighborhood. That was a mistake. He ordered the ball and said it should be in next week. He forgot to mention he would be on vacation for two weeks. When, a month later, the ball came in, he ignored my mention of being blind and needing to throw a straight ball and he drilled the finger holes for a hook ball. I certainly won’t be doing business with him again nor would I recommend him to anyone.
I started off lucky this year, but all the various handicaps with me and the ball before it was filled and redrilled played havoc. I was trying to learn to bowl with the Crow Boot, increasing visual impairment and a ball most definitely not reacting to my typical throw. I had plenty of nights where breaking 200 was an impossibility. That’s a 200 total between three games I could not do. My high game was a 157. I had to take time off from both leagues post victrectomy, and seem to be going a little stronger now.
I need of course to acknowledge my teammates in both leagues. Almost all are new teammates this year, and have been accommodating to my gimpiness. I am in less competitive leagues, and while I tremendously miss some prior years’ teammates, I still feel lucky to be bowling with such understanding people.
Thursday, February 14, 2013
Eating Crow
I mentioned the orthopedic brace that is a permanent fixture, but neglected to ever cover what it was here. It’s called a Crow Boot. Pictures are readily available through any online search. I could post one here, but considering the blind angle, I decided early on that this would be a text site with no pictures.
The Crow Boot has two halves, upper and lower. It’s made of lightweight but highly durable black plastic and is lined with lightweight foam. When fitted for it originally, they took a cast mold of my leg. They have had to add foam as the Charcot swelling on the leg decreased. My foot goes into the lower half. The upper half then interlocks and is held in place with velcro.
The Crow Boot is needed because of the Charcot Foot. As it turned out, prednisone being dropped in my eye post retina reattachment went to work on the swelling of the Charcot Foot. When I had temporarily discontinued the prednisone, the foot swelled back up worse than before. My underlying injury seems to have been tendon damage rather than a broken bone, and the foot thickly swelled up to and even slightly beyond the knee. This swelling reduced circulation already naturally impeded by more than 35 years of diabetes. Oddly enough, as long as I kept exerting and moving I was fine. When I truly stayed off the foot–after last May’s development of a toes infection also triggered by the lack of circulation–the ankle collapsed. The central bone in the ankle, the one on which the tibia’s cupped end sits, and the inner part of the heel bone soften, collapsed and twisted. My right leg is now about a half inch shorter than the left.
The Crow Boot does nothing directly for any aspect of Charcot Foot. It compensates for the structural collapse and weakness that is a permanent disability.
The Crow boot immobilizes the ankle to make sure I cannot do further damage to myself. It also diverts weight from the ankle to the ball of the foot or the upper calf. It has a lifter to compensate for the different leg lengths.
I wear the Crow Boot when not in bed or in the shower. Even to get up in the middle of the night for a leak or a snack, I need to put the Crow Boot on. I’m still living in a place with way too many stairs for a blind guy with a bad leg.
Without the boot, I would need crutches. Times when I do "cheat" and use neither the boot nor the crutches leave me feeling the error for a few days.
I do not complain about the boot. I’d be able to marginally get around on crutches, but all these stairs would be a lot more difficult, and I would not be able to bowl. The Crow Boot is bulky, and on my right foot, so I probably would not be able to drive with it due to pedal spacing, but driving was lost a half year before due to the eyesight. The boot is inflexible at the ankle and sole, so even slight bumps or lumps in a smooth surface can make me feel like I am about to fall over.
When I say I am limping along, I mean that literally. Blind eyes and a bad leg is an especially bad combination.
The Crow Boot has two halves, upper and lower. It’s made of lightweight but highly durable black plastic and is lined with lightweight foam. When fitted for it originally, they took a cast mold of my leg. They have had to add foam as the Charcot swelling on the leg decreased. My foot goes into the lower half. The upper half then interlocks and is held in place with velcro.
The Crow Boot is needed because of the Charcot Foot. As it turned out, prednisone being dropped in my eye post retina reattachment went to work on the swelling of the Charcot Foot. When I had temporarily discontinued the prednisone, the foot swelled back up worse than before. My underlying injury seems to have been tendon damage rather than a broken bone, and the foot thickly swelled up to and even slightly beyond the knee. This swelling reduced circulation already naturally impeded by more than 35 years of diabetes. Oddly enough, as long as I kept exerting and moving I was fine. When I truly stayed off the foot–after last May’s development of a toes infection also triggered by the lack of circulation–the ankle collapsed. The central bone in the ankle, the one on which the tibia’s cupped end sits, and the inner part of the heel bone soften, collapsed and twisted. My right leg is now about a half inch shorter than the left.
The Crow Boot does nothing directly for any aspect of Charcot Foot. It compensates for the structural collapse and weakness that is a permanent disability.
The Crow boot immobilizes the ankle to make sure I cannot do further damage to myself. It also diverts weight from the ankle to the ball of the foot or the upper calf. It has a lifter to compensate for the different leg lengths.
I wear the Crow Boot when not in bed or in the shower. Even to get up in the middle of the night for a leak or a snack, I need to put the Crow Boot on. I’m still living in a place with way too many stairs for a blind guy with a bad leg.
Without the boot, I would need crutches. Times when I do "cheat" and use neither the boot nor the crutches leave me feeling the error for a few days.
I do not complain about the boot. I’d be able to marginally get around on crutches, but all these stairs would be a lot more difficult, and I would not be able to bowl. The Crow Boot is bulky, and on my right foot, so I probably would not be able to drive with it due to pedal spacing, but driving was lost a half year before due to the eyesight. The boot is inflexible at the ankle and sole, so even slight bumps or lumps in a smooth surface can make me feel like I am about to fall over.
When I say I am limping along, I mean that literally. Blind eyes and a bad leg is an especially bad combination.
Sunday, February 10, 2013
The One Eye Plow Guy
My right eye went dark in 2003. I failed to leave a cornea abrasion covered long enough. The eye looked around the obstruction. The muscles pulled to the outside and peeled the retina off the back of the eye. Diabetic retinapathy, opportunistic of other problems.
I started plowing in 2006, in part because other peoples’ unreliability had crossed all acceptable lines. The city had thoroughly plowed me in, not just with a massive plow ridge, but by moving the snow from the main street to the dead-end access that led to my parking. I had a contractor plowing, but he vacationed to Florida every February. I have not driven since October 2011 but only sold the jeep two months ago. I’m feeling that loss and it triggers feelings of uselessness and helplessness via things outside my control. These things are issues I had handled after experiencing them but have come full circle.
I can only accept limitations. I can only try to impress those genuine limitations on others. A blind guy with a bad leg and reliance on an orthopedic boot brace cannot go shovel someone else’s car out.
I was good at the plowing. The first snowfall after I obtained the Jeep Wrangler was a minor but complicated storm. An inch of snow fell, then turned to rain. The precipitation stopped when a cold front blew in and froze the slush. Wanting to practice and play with the new equipment, I plowed the properties I managed. The tenants were thrilled. Their home lots were bare dry pavement while everywhere else, work, commercial establishments and most municipal streets, were slicked over with layers of ice that remained for days.
I no longer have the equipment to do that because I am no longer equipped to operate the equipment. I did not stop driving because someone made me, or because I had gotten into a serious accident because I was driving past the time I should have been. I stopped on my own because I didn’t want to kill myself or someone else.
Medications combine with insulin fluctuations to trigger periods of vertigo. I have a hard enough time moving and standing without carrying things when the ground is smooth and dry. Snowstorms had been my active times since 2006, and also periods of productive alone time. I miss those aspects. I would prefer to be able to continue some of them, but that’s now physically possible for me any longer. There’s a negative emotional charge to the entire situation for me.
A Wrangler is one of the shortest vehicles that can handle a plow (and I still burned out two transmissions.) Mine was equipped with the narrowest plow blade available. I could get into tight areas despite the fact that my field of vision was reduced and I lacked depth perception. I really was performing beyond my physical capabilities
Those physical capabilities are further diminished now, permanently. I am learning to accept that. Can others do the same?
I started plowing in 2006, in part because other peoples’ unreliability had crossed all acceptable lines. The city had thoroughly plowed me in, not just with a massive plow ridge, but by moving the snow from the main street to the dead-end access that led to my parking. I had a contractor plowing, but he vacationed to Florida every February. I have not driven since October 2011 but only sold the jeep two months ago. I’m feeling that loss and it triggers feelings of uselessness and helplessness via things outside my control. These things are issues I had handled after experiencing them but have come full circle.
I can only accept limitations. I can only try to impress those genuine limitations on others. A blind guy with a bad leg and reliance on an orthopedic boot brace cannot go shovel someone else’s car out.
I was good at the plowing. The first snowfall after I obtained the Jeep Wrangler was a minor but complicated storm. An inch of snow fell, then turned to rain. The precipitation stopped when a cold front blew in and froze the slush. Wanting to practice and play with the new equipment, I plowed the properties I managed. The tenants were thrilled. Their home lots were bare dry pavement while everywhere else, work, commercial establishments and most municipal streets, were slicked over with layers of ice that remained for days.
I no longer have the equipment to do that because I am no longer equipped to operate the equipment. I did not stop driving because someone made me, or because I had gotten into a serious accident because I was driving past the time I should have been. I stopped on my own because I didn’t want to kill myself or someone else.
Medications combine with insulin fluctuations to trigger periods of vertigo. I have a hard enough time moving and standing without carrying things when the ground is smooth and dry. Snowstorms had been my active times since 2006, and also periods of productive alone time. I miss those aspects. I would prefer to be able to continue some of them, but that’s now physically possible for me any longer. There’s a negative emotional charge to the entire situation for me.
A Wrangler is one of the shortest vehicles that can handle a plow (and I still burned out two transmissions.) Mine was equipped with the narrowest plow blade available. I could get into tight areas despite the fact that my field of vision was reduced and I lacked depth perception. I really was performing beyond my physical capabilities
Those physical capabilities are further diminished now, permanently. I am learning to accept that. Can others do the same?
Saturday, February 9, 2013
Snowblind!
I write from Providence, Rhode Island. I am told by roommate and TV media that everything out there is covered by some 20 inches of snow. I can’t see for myself.
It’s not just that basic fact that depresses me. I used to drive a Jeep Wrangler equipped with a plow rig. I never went out and hustled work, but used the truck to maintain the buildings I managed. I picked up occasional local jobs, but the purpose of owning the rig from the beginning was to be self sufficient. In 2005, the city ran out of space to put the snow on the main street and had plowed in the side street that serves as only access to the parking.
I sold the Jeep and plow rig last December, long after I should have. I had last driven it in October 2011.
There’s no self sufficiency left, for the storm or the property management or much of anything else. Things I was real familiar with I can still do. That list grows short. The combination of blind eyes and structurally deficient leg is a particularly bad one. I can’t really shovel 3 inches of light and fluffy snow. Twenty inches of the wet and heavy stuff is beyond me. I know that. I’m not writing it to whine or solicit help, but to add a layer of acceptance to my condition. Like not selling the Jeep for fourteen months after I could last drive it, sometimes the coping mechanism works slower than "it should."
The more valuable analogy for this post is the blizzard blinding white out. My eyes are like that all the time, although the level varies. Car visibility is measured in quarter miles. My visibility is measured in feet, but the cause and effect are identical. If there’s too much gunk between you and what you’re looking at, you just can’t see it.
It’s not just that basic fact that depresses me. I used to drive a Jeep Wrangler equipped with a plow rig. I never went out and hustled work, but used the truck to maintain the buildings I managed. I picked up occasional local jobs, but the purpose of owning the rig from the beginning was to be self sufficient. In 2005, the city ran out of space to put the snow on the main street and had plowed in the side street that serves as only access to the parking.
I sold the Jeep and plow rig last December, long after I should have. I had last driven it in October 2011.
There’s no self sufficiency left, for the storm or the property management or much of anything else. Things I was real familiar with I can still do. That list grows short. The combination of blind eyes and structurally deficient leg is a particularly bad one. I can’t really shovel 3 inches of light and fluffy snow. Twenty inches of the wet and heavy stuff is beyond me. I know that. I’m not writing it to whine or solicit help, but to add a layer of acceptance to my condition. Like not selling the Jeep for fourteen months after I could last drive it, sometimes the coping mechanism works slower than "it should."
The more valuable analogy for this post is the blizzard blinding white out. My eyes are like that all the time, although the level varies. Car visibility is measured in quarter miles. My visibility is measured in feet, but the cause and effect are identical. If there’s too much gunk between you and what you’re looking at, you just can’t see it.
Tuesday, December 4, 2012
Waiting
I can’t hide the fact that I am blind anymore.
The Charcot foot has stabilized, but the vision has gotten worse. Not enough light is always too dark, too much light is a hazy bright blur, and just the "right" amount of light leave everything backlit and in indiscernible shadows.
The range of vision is one to two feet, depending on lighting, and usually without the ability to discern fingers unless there is a sharp background. I can’t see well enough to recognize people by sight at any distance. I’ve always been good with voices and other cues, and try to stretch those abilities as best as I can.
I adjust as I stare at the computer, but looking away makes everything worse, and stepping away will often leave me unable to refocus on the bright screen. Most often, light hurts. As I physically tire or exert, my vision also diminishes.
Things have gotten worse month by month. So take out the violin...
And crash it into my skull.I say this to be informative to the people who watch me walk like a crippled great-great grandpa and turn to a caller with that blank blind look in my eyes. I’m still doing everything I can, with the acknowledgment that what I can do is lessening almost daily. I can do less and do everything more slowly. I’ve been trying to accept the new, ever increasing limitations and to stop pushing myself.
For lack of choice in my life, I am learning to relax.
I’ve made progress on completing things that have been on hold in the three-plus years since the Cialis-induced blood hemorrhage. I’m looking to complete final things so I can turn over my responsibilities in an orderly and accessible manner. The more I complete, the better relax. The time for waiting in hope that tomorrow or next week or next month may be better is over.
There’s another procedure in January, and there is some hope of improvement after that. Things may be clearer if the worsening situation is the result of the vitreous being dirty.
Until then, I am waiting and deferring many other decisions.
People have noticed by this blog and in person that I am not talking as hopefully as I had been. This isn’t a matter of giving up, but a matter of perspective. I’m all for optimism, but I am more for realism. I’m finding the balance between the two and holding on to each.
The Charcot foot has stabilized, but the vision has gotten worse. Not enough light is always too dark, too much light is a hazy bright blur, and just the "right" amount of light leave everything backlit and in indiscernible shadows.
The range of vision is one to two feet, depending on lighting, and usually without the ability to discern fingers unless there is a sharp background. I can’t see well enough to recognize people by sight at any distance. I’ve always been good with voices and other cues, and try to stretch those abilities as best as I can.
I adjust as I stare at the computer, but looking away makes everything worse, and stepping away will often leave me unable to refocus on the bright screen. Most often, light hurts. As I physically tire or exert, my vision also diminishes.
Things have gotten worse month by month. So take out the violin...
And crash it into my skull.I say this to be informative to the people who watch me walk like a crippled great-great grandpa and turn to a caller with that blank blind look in my eyes. I’m still doing everything I can, with the acknowledgment that what I can do is lessening almost daily. I can do less and do everything more slowly. I’ve been trying to accept the new, ever increasing limitations and to stop pushing myself.
For lack of choice in my life, I am learning to relax.
I’ve made progress on completing things that have been on hold in the three-plus years since the Cialis-induced blood hemorrhage. I’m looking to complete final things so I can turn over my responsibilities in an orderly and accessible manner. The more I complete, the better relax. The time for waiting in hope that tomorrow or next week or next month may be better is over.
There’s another procedure in January, and there is some hope of improvement after that. Things may be clearer if the worsening situation is the result of the vitreous being dirty.
Until then, I am waiting and deferring many other decisions.
People have noticed by this blog and in person that I am not talking as hopefully as I had been. This isn’t a matter of giving up, but a matter of perspective. I’m all for optimism, but I am more for realism. I’m finding the balance between the two and holding on to each.
Saturday, October 20, 2012
Feeling it Out: Mid Life
My experience of watching other men deal with their mid life crises had provided me experience than just with my father, who is the type who would probably deny ever having had a mid life crisis. Fathers, bosses, mentors...most ruined things for themselves in one way or another. I sought to avoid that.
I had that "what to do and how to get there" life crisis early, at high school rather than college age. It’s no surprise my mid life crisis came at 36 rather than in my 40’s. It was mild. I developed an uncharacteristic infatuation that I could not make develop. I regretted having little financial savings. I listened to other people who told me I should be taking care of myself better health-wise.
At 43, I am still shunned by the former object of my affections. My main means of savings is still home ownership and equity–always iffy in this economy. And now I am not only disabled but feel like crap.
My diet had never been bad. The sole dietary change I made was switching from real sugar to Equal in my morning coffee. I had developed the sugar habit to boost my sugar in the days when I could not actually afford to eat anything for breakfast. That had changed. The other significant change when I started "taking care of myself better" was following my GP’s guidelines of taking a much higher insulin dose at night. It made sense to me as I knew by feel that overnights were the main time I sugar would rise to uncomfortable levels.
My sugars did lower, although never to the A1C numbers my doctor wanted to see. I was no longer getting up in the night to go pee. Instead, I was not able to sleep because the sugar levels felt too low. Too high, and I don’t get good sleep because I’m off to the bathroom a few times each night. Too low, I just can’t actually fall asleep.
I still seldom find that right balance.
This past spring and summer, I made a renewed effort to get my sugars lower, no matter how I felt. The inflamed Charcot foot had further impeded my circulation enough to cause the quick and massive infection that almost cost me a toe. The night of that hospital admittance also emphasized one particular problem food that raises sugars beyond expectations. (Low fat milk, which I will address in detail before long.) I succeeded, and am feeling so much worse for it.
Here’s how the diabetic things feel these days.
My blood pressure went back to normal levels when the Charcot inflammation subsided. The reduced swelling is probably more of a by product of the prednisone I still must drop into my eye than true healing. The foot is stable, but the Crow boot is a permanent fixture due to the ankle collapse suffered from the reduced circulation. I have frequent vertigo issues, which is probably a combination of the eye maladies and reaction to blood pressure medication meant for a worse situation than I am now in. Any of the four to five eye drop medications may also play into the vertigo.
My eye is a mess and my vision is getting worse. The strobing light exams contribute to this. The eye drops reduce vision at least temporarily when taken. Debris may be built up in the silicone oil that still remains in my eye. Light sensitivity is still blinding, darkness vision is non-existent, and the "retinapathy veil" grows darker. On doctor’s instructions, I had stopped the eye pressure drops when the pressure was good, and it re-rose to scary levels, so those drops are to be continued indefinitely. The prednisone still gives stomach problems, but not as severe as they were last winter.
Long story short, I’m the mess I had sought to avoid ever becoming after re-examining life in middle age. Maybe that "male menopause" just can’t be avoided.
I had that "what to do and how to get there" life crisis early, at high school rather than college age. It’s no surprise my mid life crisis came at 36 rather than in my 40’s. It was mild. I developed an uncharacteristic infatuation that I could not make develop. I regretted having little financial savings. I listened to other people who told me I should be taking care of myself better health-wise.
At 43, I am still shunned by the former object of my affections. My main means of savings is still home ownership and equity–always iffy in this economy. And now I am not only disabled but feel like crap.
My diet had never been bad. The sole dietary change I made was switching from real sugar to Equal in my morning coffee. I had developed the sugar habit to boost my sugar in the days when I could not actually afford to eat anything for breakfast. That had changed. The other significant change when I started "taking care of myself better" was following my GP’s guidelines of taking a much higher insulin dose at night. It made sense to me as I knew by feel that overnights were the main time I sugar would rise to uncomfortable levels.
My sugars did lower, although never to the A1C numbers my doctor wanted to see. I was no longer getting up in the night to go pee. Instead, I was not able to sleep because the sugar levels felt too low. Too high, and I don’t get good sleep because I’m off to the bathroom a few times each night. Too low, I just can’t actually fall asleep.
I still seldom find that right balance.
This past spring and summer, I made a renewed effort to get my sugars lower, no matter how I felt. The inflamed Charcot foot had further impeded my circulation enough to cause the quick and massive infection that almost cost me a toe. The night of that hospital admittance also emphasized one particular problem food that raises sugars beyond expectations. (Low fat milk, which I will address in detail before long.) I succeeded, and am feeling so much worse for it.
Here’s how the diabetic things feel these days.
My blood pressure went back to normal levels when the Charcot inflammation subsided. The reduced swelling is probably more of a by product of the prednisone I still must drop into my eye than true healing. The foot is stable, but the Crow boot is a permanent fixture due to the ankle collapse suffered from the reduced circulation. I have frequent vertigo issues, which is probably a combination of the eye maladies and reaction to blood pressure medication meant for a worse situation than I am now in. Any of the four to five eye drop medications may also play into the vertigo.
My eye is a mess and my vision is getting worse. The strobing light exams contribute to this. The eye drops reduce vision at least temporarily when taken. Debris may be built up in the silicone oil that still remains in my eye. Light sensitivity is still blinding, darkness vision is non-existent, and the "retinapathy veil" grows darker. On doctor’s instructions, I had stopped the eye pressure drops when the pressure was good, and it re-rose to scary levels, so those drops are to be continued indefinitely. The prednisone still gives stomach problems, but not as severe as they were last winter.
Long story short, I’m the mess I had sought to avoid ever becoming after re-examining life in middle age. Maybe that "male menopause" just can’t be avoided.
Tuesday, October 9, 2012
Blood Sugar Downer
The change in Wal-Mart generic insulin manufacture has brought more frequent periods of discomfort with "low" sugar levels. I use quotes on "low" as acknowledgment that this is by feel, not by blood testing numbers.
Overall the sugar has felt lower with the Novolin than it had been with the Humulin formula. Since the toe problem that landed me in the hospital in the spring, I was making a concentrated effort for an overall lowering of the blood sugar. The change in insulin seems to have made a sharper change in that direction, unfortunately at a time when I was looking to slowly raise it again so I would feel overall better health.
People, including my GP, do not understand that last statement. Diabetics do. I do not feel as good when the sugars are lower. Diabetics who are good doobies and paint by numbers also report that they feel less well when their sugars are at better numbers. I’m still waiting for that lucky day when I meet a doctor who understands that how a patient feels is somewhat more important than what test numbers statistically say about their health. At least two of the three other diabetics with whom I have most recently spoken with in general terms report that they primary care givers and/or diabetic specialists have railed against missed target numbers without regard to how the patients were actually feeling, so I am not holding my breath on meeting the more compassionate and logical doctor. Both of those acquaintances were discouraged that no effort seems enough.
I have never recovered the feelings of wellness and functionality I possessed prior to "taking care of myself better." By the full chains of events, I would not be blind nor crippled by the collapsed ankle via Charcot foot if I had not started taking care of myself better. I My numbers had risen again and things got better, but never back to where they had been, even discounting the blind thing and the cripple thing.
I did make a renewed effort on my own after this spring’s hospitalization. The Charcot foot had nearly totally impeded circulation in the foot, allowing for the sudden infection and almost instantaneous gangrene and the collapse of the bone structure that has permanently impaired my ankle. My largest steps were to eliminate as much of the big (and hidden) source of sugar in my diet as possible, and letting my sugar levels stay at critically low feeling longer than I usually would.
I don’t need an A1C test to know I have succeeded. I don’t feel as well as I did prior to the hospitalization. Fatigue is constant. When the sugar hits a low feel level, the physical symptoms hit much sooner after the temperament issues than they used to. Those temperament issues are more severe and the "calm" times between are periods of severe depression that is biochemically impacted beyond the constant "useless gimp" feelings that are situational depression that anyone would feel in my situation. My thoughts are usually slower. I tire more easily. Stamina is gone. Neuropathy burns are more frequent. The depression had reached such an abyss that I found no choice other than to resume antidepressants.
Does this sound like healthier living?
It sure don’t feel like it.
Overall the sugar has felt lower with the Novolin than it had been with the Humulin formula. Since the toe problem that landed me in the hospital in the spring, I was making a concentrated effort for an overall lowering of the blood sugar. The change in insulin seems to have made a sharper change in that direction, unfortunately at a time when I was looking to slowly raise it again so I would feel overall better health.
People, including my GP, do not understand that last statement. Diabetics do. I do not feel as good when the sugars are lower. Diabetics who are good doobies and paint by numbers also report that they feel less well when their sugars are at better numbers. I’m still waiting for that lucky day when I meet a doctor who understands that how a patient feels is somewhat more important than what test numbers statistically say about their health. At least two of the three other diabetics with whom I have most recently spoken with in general terms report that they primary care givers and/or diabetic specialists have railed against missed target numbers without regard to how the patients were actually feeling, so I am not holding my breath on meeting the more compassionate and logical doctor. Both of those acquaintances were discouraged that no effort seems enough.
I have never recovered the feelings of wellness and functionality I possessed prior to "taking care of myself better." By the full chains of events, I would not be blind nor crippled by the collapsed ankle via Charcot foot if I had not started taking care of myself better. I My numbers had risen again and things got better, but never back to where they had been, even discounting the blind thing and the cripple thing.
I did make a renewed effort on my own after this spring’s hospitalization. The Charcot foot had nearly totally impeded circulation in the foot, allowing for the sudden infection and almost instantaneous gangrene and the collapse of the bone structure that has permanently impaired my ankle. My largest steps were to eliminate as much of the big (and hidden) source of sugar in my diet as possible, and letting my sugar levels stay at critically low feeling longer than I usually would.
I don’t need an A1C test to know I have succeeded. I don’t feel as well as I did prior to the hospitalization. Fatigue is constant. When the sugar hits a low feel level, the physical symptoms hit much sooner after the temperament issues than they used to. Those temperament issues are more severe and the "calm" times between are periods of severe depression that is biochemically impacted beyond the constant "useless gimp" feelings that are situational depression that anyone would feel in my situation. My thoughts are usually slower. I tire more easily. Stamina is gone. Neuropathy burns are more frequent. The depression had reached such an abyss that I found no choice other than to resume antidepressants.
Does this sound like healthier living?
It sure don’t feel like it.
Wednesday, September 19, 2012
Diabetes Complications: Neuropathy
Diabetes stands as one of or the very mos common causes of neuropathy, specifically the forms of neuropathy frequently called diabetic neuropathy or peripheral neuropathy.
Diabetic neuropathy roots solely from the diabetic condition rather than external injury or toxin exposure or infection. Diabetes is just one of a number of metabolic disorders that can lead to neuropathy. Diabetes is at its core a major metabolic disorder. Neuropathy is all but inevitable in diabetes.
Peripheral neuropathy is nerve damage away from the brain and spine, which form the center of the nervous system. The nerves are damaged. With diabetics, reduced circulation–also a near inevitability–causes the nerve damage. In my experience, doctors downplay the inevitabilities of diabetes because they are afraid patients will too quickly resign themselves to the eventualities without ever truly trying to take care of themselves. These problems are nearly inevitable, but the lack of self care will bring the problems sooner rather than later. I seek to communicate more honestly than doctors have by my experience, but am not dispensing medical advice. Nor do I think much of anyone who gives in to the negatives without a fight. "Inevitable" should never be interpreted as "immediate."
The nerve damage can affect sensations of temperature and pain. Neuropathy causes pain and numbness, most frequently in the hands and feet. This is the source of foot problems and high risk for them among diabetics. If the diabetic cannot feel pain in his feet, he can be unaware of injuries. Ignorance of bone problems most often results in my friend Charcot Foot. The more common risk that plays out is infections from cuts, punctures and abrasions on the feet that the diabetic cannot feel. Diabetics should wear socks and shoes at all times in an effort to prevent avoidable problems. Yet, as always with this miserable conditions, the patient must also take precautions with the precautions. Socks should not be so tight as to reduce circulation. Shoes should be well fitted, neither tight enough to cut into the feet nor loose enough to cause friction burns and abrasions. Shoes should never be worn without socks. Open wounds caused by shoes can be the most sinister; their gradual development makes them the easiest to not realize you have caused.
I learned one thing about neuropathy in a hard way that almost cost me my life. The neuropathy and generalized reduced diabetic circulation in my feet have made "toe testing" of water temperatures completely unreliable. On a friend’s boat a few years back, I had sat in the back with my feet in the water. It didn’t seem that cold. I dove in. The water was cold, so cold it triggered shock. I almost drown. Conversely, bath water might be much hotter than the diabetic toe can judge. Always check with an elbow rather than an extremity.
The neuropathy topic directly bridges into the running blood sugar testing topic. Please note the information from earlier in this post, a very subtle point in the overview: "Diabetic neuropathy roots solely from the diabetic condition rather than external injury..." Medical professionals probably will not point out to you that all the finger pricking of traditional home testing is likely to advance or cause neuropathy in the patient’s fingertips. You cannot keep sticking lancets into your fingertips without causing nerve damage on some level. This, and not the discomfort, prompted the recent push for non fingertip testing. Some sources on the net do not cite better than the 10% inaccuracy of arm testing than the patient could see with urine testing.
This risk to the fingertip nerves stood as one of my rationalizations against hopping on the home meter testing bandwagon. Again I warn: I have managed my diabetes with care, but in contrast to modern preferences and standards. I recommend anyone reading this to have frank conversations with their doctors before just doing what I do, and recent Type 2 diagnoses will require some form of home testing.
Diabetic neuropathy roots solely from the diabetic condition rather than external injury or toxin exposure or infection. Diabetes is just one of a number of metabolic disorders that can lead to neuropathy. Diabetes is at its core a major metabolic disorder. Neuropathy is all but inevitable in diabetes.
Peripheral neuropathy is nerve damage away from the brain and spine, which form the center of the nervous system. The nerves are damaged. With diabetics, reduced circulation–also a near inevitability–causes the nerve damage. In my experience, doctors downplay the inevitabilities of diabetes because they are afraid patients will too quickly resign themselves to the eventualities without ever truly trying to take care of themselves. These problems are nearly inevitable, but the lack of self care will bring the problems sooner rather than later. I seek to communicate more honestly than doctors have by my experience, but am not dispensing medical advice. Nor do I think much of anyone who gives in to the negatives without a fight. "Inevitable" should never be interpreted as "immediate."
The nerve damage can affect sensations of temperature and pain. Neuropathy causes pain and numbness, most frequently in the hands and feet. This is the source of foot problems and high risk for them among diabetics. If the diabetic cannot feel pain in his feet, he can be unaware of injuries. Ignorance of bone problems most often results in my friend Charcot Foot. The more common risk that plays out is infections from cuts, punctures and abrasions on the feet that the diabetic cannot feel. Diabetics should wear socks and shoes at all times in an effort to prevent avoidable problems. Yet, as always with this miserable conditions, the patient must also take precautions with the precautions. Socks should not be so tight as to reduce circulation. Shoes should be well fitted, neither tight enough to cut into the feet nor loose enough to cause friction burns and abrasions. Shoes should never be worn without socks. Open wounds caused by shoes can be the most sinister; their gradual development makes them the easiest to not realize you have caused.
I learned one thing about neuropathy in a hard way that almost cost me my life. The neuropathy and generalized reduced diabetic circulation in my feet have made "toe testing" of water temperatures completely unreliable. On a friend’s boat a few years back, I had sat in the back with my feet in the water. It didn’t seem that cold. I dove in. The water was cold, so cold it triggered shock. I almost drown. Conversely, bath water might be much hotter than the diabetic toe can judge. Always check with an elbow rather than an extremity.
The neuropathy topic directly bridges into the running blood sugar testing topic. Please note the information from earlier in this post, a very subtle point in the overview: "Diabetic neuropathy roots solely from the diabetic condition rather than external injury..." Medical professionals probably will not point out to you that all the finger pricking of traditional home testing is likely to advance or cause neuropathy in the patient’s fingertips. You cannot keep sticking lancets into your fingertips without causing nerve damage on some level. This, and not the discomfort, prompted the recent push for non fingertip testing. Some sources on the net do not cite better than the 10% inaccuracy of arm testing than the patient could see with urine testing.
This risk to the fingertip nerves stood as one of my rationalizations against hopping on the home meter testing bandwagon. Again I warn: I have managed my diabetes with care, but in contrast to modern preferences and standards. I recommend anyone reading this to have frank conversations with their doctors before just doing what I do, and recent Type 2 diagnoses will require some form of home testing.
Wednesday, September 12, 2012
Odd and Mismated
There’s been arguin’ goin’ on ‘round these parts. All my fault, of course.
I have now had time to fully psychologically accept the fact that the Crow Boot is a permanent fixture on my right foot. It will probably only become unnecessary when the eventual inevitability of amputation occurs.
I cannot move around without the Crow Boot, or more unwieldy, crutches. I am not very coordinated with the crutches and they prevent any real use of my hands. As clunky and indiscreet as the Crow Boot is, I appreciate having it because I would be totally useless without it. Putting weight on the right ankle risks further collapse and the even more gruesome possibility that the tibia could fall off its structure and pierce the skin from the inside.
With this acceptance comes the realization that I have a lot of shoes, specifically right-foot shoes, that are useless to me. The argument with the roommate started when I asked about the VA or other places that may want donation of single shoes. I was told how absurd the concept was and railed to throw the useless things away.
I don’t remember where I heard about one shoe donations. It could have been an Ann Landers column of decades past, or something during my lucrative time selling shoes with Filene’s. The desire for donations like that was just an oddity that stuck with me.
Other people I asked had never heard of such a thing either, although those conversations did not degenerate into arguments about people who hoard trash.
I sold shoes for a living. I am a diabetic who always took the basics of foot care seriously enough that I seldom bought cheap shoes and I never "suffered" shoes that hurt my feet. The ones that weren’t comfortable got put into donation bins where they could hurt the feet of needy people who statistically would not be diabetics.
I’m not a fashionable guy, but low end shoes for me are Skechers and Bass. I’ve shown brand loyalty to Clarks, Timberland and Johnston & Murphy. As the thought was not to pass off cheap ass shoes to people, I really don’t think I was crazy for thinking that these things could serve a purpose greater than landfill.
I should have just gone to the internet rather than asking around. I found a list of organizations seeking such donations at http://www.amputee-coalition.org/fact_sheets/oddshoe.html
There’s great resources there both for people looking for one-shoe sources and those in a position to donate.
Calling the Providence Veterans/VA hospital did net the best, nost immediate results.
Maybe I am crazy, but not about this.
I have now had time to fully psychologically accept the fact that the Crow Boot is a permanent fixture on my right foot. It will probably only become unnecessary when the eventual inevitability of amputation occurs.
I cannot move around without the Crow Boot, or more unwieldy, crutches. I am not very coordinated with the crutches and they prevent any real use of my hands. As clunky and indiscreet as the Crow Boot is, I appreciate having it because I would be totally useless without it. Putting weight on the right ankle risks further collapse and the even more gruesome possibility that the tibia could fall off its structure and pierce the skin from the inside.
With this acceptance comes the realization that I have a lot of shoes, specifically right-foot shoes, that are useless to me. The argument with the roommate started when I asked about the VA or other places that may want donation of single shoes. I was told how absurd the concept was and railed to throw the useless things away.
I don’t remember where I heard about one shoe donations. It could have been an Ann Landers column of decades past, or something during my lucrative time selling shoes with Filene’s. The desire for donations like that was just an oddity that stuck with me.
Other people I asked had never heard of such a thing either, although those conversations did not degenerate into arguments about people who hoard trash.
I sold shoes for a living. I am a diabetic who always took the basics of foot care seriously enough that I seldom bought cheap shoes and I never "suffered" shoes that hurt my feet. The ones that weren’t comfortable got put into donation bins where they could hurt the feet of needy people who statistically would not be diabetics.
I’m not a fashionable guy, but low end shoes for me are Skechers and Bass. I’ve shown brand loyalty to Clarks, Timberland and Johnston & Murphy. As the thought was not to pass off cheap ass shoes to people, I really don’t think I was crazy for thinking that these things could serve a purpose greater than landfill.
I should have just gone to the internet rather than asking around. I found a list of organizations seeking such donations at http://www.amputee-coalition.org/fact_sheets/oddshoe.html
There’s great resources there both for people looking for one-shoe sources and those in a position to donate.
Calling the Providence Veterans/VA hospital did net the best, nost immediate results.
Maybe I am crazy, but not about this.
Sunday, September 2, 2012
Caution: Blind Bowler!
Bowling has resumed. It’s one of the last things I can still do at all. Like anything else, I can’t do it as well, but I am lucky to have very patient teammates who sacrifice competitive edge yo bowl with a blind guy who has to cover the Crow Boot with a pillowcase.
To answer the usual and natural questions:
I have enough vision based on contrast of tone, shade and color to see the lane defined. The laminate is a very light wood color and the gutters are dark gray. I started bowling as a half-blind individual with no depth perception, so I always threw a straight ball. I line myself up for the throw and hope it stays straight.
I can see the contrast of the foul line and usually leave myself some extra space. Due to the Crow boot, I can no longer do an approach, so throw from a standing position.
The limitations of the boot are things I have to relearn. I’m not always throwing from a still position. I have to unlearn habits.
My teammates tell me what pins are still standing after the first throw. I try to realign according to pin positions. We hope for the best.
Obviously, I am bowling with some helpful and patient people. That they bowl on a team with me demonstrates good things about their characters. The people bowling for competition rather than a weekly social event aren’t as patient. It all depends on where the individual emphasis is.
I feel awkward sometimes about the heightened need. When my teammates get absorbed in their conversation, I need to interrupt or wait patiently to be told what pins to shoot for. I feel like a toddler on a carousel, waving frantically in demand for attention with every revolution. I don’t see well enough to even be able to pretend to be able to pay comparable attention to the efforts of my teammates or the opposition, and that does trigger twinges of guilt. I firmly believe in all people being equal, with everyone having times when they are a priority. I don’t indulge people who think they are always the priority, so truly hate anything that pushes me in that direction.
I can do as well as I can in part because the nature of it being a competitive sport, the lighting is well researched and planned. Lighting is very uniform, without glare, and never in my eyes. It’s actually one of the more comfortable places for me.
Vision is tougher when I am not actually facing the lanes. People are still shadowy and darkened. Identify individuals more by shape and body language and voice than by traditional ways. I am one of those people who always had a problem with faces, so a lifetime of adjusting to that may have become an asset in dealing with the vision loss. I do not often stray away from my table to socialize unless I am fairly certain who I will be bumping into (which all too often is literal.)
The first week of competition in the Thursday League achieved 83, 102 and 115. That’s certainly not competition for High Average awards, but should be a good enough foundation to realistically build off of as I relearn the sport with my new status quo of limitations.
To answer the usual and natural questions:
I have enough vision based on contrast of tone, shade and color to see the lane defined. The laminate is a very light wood color and the gutters are dark gray. I started bowling as a half-blind individual with no depth perception, so I always threw a straight ball. I line myself up for the throw and hope it stays straight.
I can see the contrast of the foul line and usually leave myself some extra space. Due to the Crow boot, I can no longer do an approach, so throw from a standing position.
The limitations of the boot are things I have to relearn. I’m not always throwing from a still position. I have to unlearn habits.
My teammates tell me what pins are still standing after the first throw. I try to realign according to pin positions. We hope for the best.
Obviously, I am bowling with some helpful and patient people. That they bowl on a team with me demonstrates good things about their characters. The people bowling for competition rather than a weekly social event aren’t as patient. It all depends on where the individual emphasis is.
I feel awkward sometimes about the heightened need. When my teammates get absorbed in their conversation, I need to interrupt or wait patiently to be told what pins to shoot for. I feel like a toddler on a carousel, waving frantically in demand for attention with every revolution. I don’t see well enough to even be able to pretend to be able to pay comparable attention to the efforts of my teammates or the opposition, and that does trigger twinges of guilt. I firmly believe in all people being equal, with everyone having times when they are a priority. I don’t indulge people who think they are always the priority, so truly hate anything that pushes me in that direction.
I can do as well as I can in part because the nature of it being a competitive sport, the lighting is well researched and planned. Lighting is very uniform, without glare, and never in my eyes. It’s actually one of the more comfortable places for me.
Vision is tougher when I am not actually facing the lanes. People are still shadowy and darkened. Identify individuals more by shape and body language and voice than by traditional ways. I am one of those people who always had a problem with faces, so a lifetime of adjusting to that may have become an asset in dealing with the vision loss. I do not often stray away from my table to socialize unless I am fairly certain who I will be bumping into (which all too often is literal.)
The first week of competition in the Thursday League achieved 83, 102 and 115. That’s certainly not competition for High Average awards, but should be a good enough foundation to realistically build off of as I relearn the sport with my new status quo of limitations.
Thursday, August 23, 2012
Ankles Aweigh!
The blind thing is enough to deal with. The ankle is an additional permanent handicap.
The basics for newer readers and people with polite curiosity about that limpy gimpy guy at East Providence Lanes a couple nights per week:
In October 2011 I unintentionally self inflicted tendon damage in my foot. Even without bone breaks or stress fractures, I developed a rare diabetic complication called Charcot "Sharko" Foot. This causes massive swelling that the body uses to protect the foot from further injury. The link tag can direct readers to more detailed posts about the condition.
Diabetic circulation is typically reduced to begin with. The massive inflammation further reduced the circulation in my right foot, and the foot was unable to get the nutrients it needed. During the periods of worst swelling and least circulation, the central bone/s of my right ankle, the talus and calcaneus, lost density and mass. This softened those bones. They moved and turned a little. The tibia no longer fits with them correctly and is permanently out of place. Direct-weight use of the ankle risks further displacement of the bones.
A "medical appliance" called a Crow Boot protects the ankle from further harm. The crow boot encases the ankle, restricts all movement, and diverts weight from the ankle to the rest of the foot and upper leg. It is awkward and clunky, but allows mobility I otherwise would not have. I am pretty bad with crutches, and my house has too many stairs, inside and out.
It’s a bulky Iron Man type contraption of hard black plastic on the outside. The inside is foam that keeps everything snug and sheltered, like a clarinet case. It’s a shell with upper and lower halves that interlock and hold together with velcro straps. With the risk that weight-bearing use of the ankle could cause the leg bone to completely fall out of place and possibly puncture the skin from the inside on the way out, I need the Crow Boot or crutches to even move around the house.
I checked the bowling center management and the United States Bowling Congress about accommodation or allowance for the boot as I certainly could not heft even my lightweight ball without the boot. As long as it is covered to prevent "outside materials" from dislodging from the boot and posing hazard to other bowlers, there are no objections or rule violations.
The Crow Boot is a permanent fixture. The ankle is not going to "uncollapse." My right leg is now about an inch shorter than the left.
Yes, I tend to move like the mummy, THUMP step THUMP step THUMP step, but that’s a lot better than not being able to move around at all.
The basics for newer readers and people with polite curiosity about that limpy gimpy guy at East Providence Lanes a couple nights per week:
In October 2011 I unintentionally self inflicted tendon damage in my foot. Even without bone breaks or stress fractures, I developed a rare diabetic complication called Charcot "Sharko" Foot. This causes massive swelling that the body uses to protect the foot from further injury. The link tag can direct readers to more detailed posts about the condition.
Diabetic circulation is typically reduced to begin with. The massive inflammation further reduced the circulation in my right foot, and the foot was unable to get the nutrients it needed. During the periods of worst swelling and least circulation, the central bone/s of my right ankle, the talus and calcaneus, lost density and mass. This softened those bones. They moved and turned a little. The tibia no longer fits with them correctly and is permanently out of place. Direct-weight use of the ankle risks further displacement of the bones.
A "medical appliance" called a Crow Boot protects the ankle from further harm. The crow boot encases the ankle, restricts all movement, and diverts weight from the ankle to the rest of the foot and upper leg. It is awkward and clunky, but allows mobility I otherwise would not have. I am pretty bad with crutches, and my house has too many stairs, inside and out.
It’s a bulky Iron Man type contraption of hard black plastic on the outside. The inside is foam that keeps everything snug and sheltered, like a clarinet case. It’s a shell with upper and lower halves that interlock and hold together with velcro straps. With the risk that weight-bearing use of the ankle could cause the leg bone to completely fall out of place and possibly puncture the skin from the inside on the way out, I need the Crow Boot or crutches to even move around the house.
I checked the bowling center management and the United States Bowling Congress about accommodation or allowance for the boot as I certainly could not heft even my lightweight ball without the boot. As long as it is covered to prevent "outside materials" from dislodging from the boot and posing hazard to other bowlers, there are no objections or rule violations.
The Crow Boot is a permanent fixture. The ankle is not going to "uncollapse." My right leg is now about an inch shorter than the left.
Yes, I tend to move like the mummy, THUMP step THUMP step THUMP step, but that’s a lot better than not being able to move around at all.
Friday, July 13, 2012
Cane-Do Attitude
The recent debate with two close friends where they were aggressively trying to sell me on the idea of using a blind man’s cane is far from the first time the suggestion reached my waxy ears.
The suggestion I remember best was around April 2010, back when I was recovering from the vitreous hemorrhage but had lost reading vision due to the improper cataract lense and was losing other overall vision due to the PRP procedure.
I was leaving the Social Security Administration and, until I was about two feet from her, did not see a woman in the double-wide hallway. Her clothes blended into the surrounding, leaving me without telltale signs of contrast.
The woman took up most of the wide hall. We're talking morbidly obese, four hundred pounds if she was an ounce. Her slow waddle removed the other sign I used to see things back then, motion, because her little feet just had more than they could readily handle.
She was obviously not used to not being seen and carried the attitude of the 400-pound gorilla in the room: she can sit wherever she wants. Even though I fully stopped short of any collision, she yelled at me to watch where I was going. I calmly apologized and said I was blind. I always try politeness as a first resort, I just don't follow through with diplomacy when it obviously will not work with specific people.
The woman continued yelling loudly to tell me that if I was blind I should be using a cane so other people could tell.
Do I need to put in more effort to compensate for other people? Do I have to rise above other people rudeness when they refuse to be polite or even mildly accommodating?
No, I don't.
I figured that if I was having a conversation with unsolicited suggestions being freely exchanged, that I should offer my own. I told her that she ought to lose weight to make more room for other people and continued on my way.
My mistake. She hadn’t been looking to exchange suggestions, only to tell me what she thought I needed to do. I never was the most socially adept person anyway. She was still screaming when the elevator doors closed.
The suggestion I remember best was around April 2010, back when I was recovering from the vitreous hemorrhage but had lost reading vision due to the improper cataract lense and was losing other overall vision due to the PRP procedure.
I was leaving the Social Security Administration and, until I was about two feet from her, did not see a woman in the double-wide hallway. Her clothes blended into the surrounding, leaving me without telltale signs of contrast.
The woman took up most of the wide hall. We're talking morbidly obese, four hundred pounds if she was an ounce. Her slow waddle removed the other sign I used to see things back then, motion, because her little feet just had more than they could readily handle.
She was obviously not used to not being seen and carried the attitude of the 400-pound gorilla in the room: she can sit wherever she wants. Even though I fully stopped short of any collision, she yelled at me to watch where I was going. I calmly apologized and said I was blind. I always try politeness as a first resort, I just don't follow through with diplomacy when it obviously will not work with specific people.
The woman continued yelling loudly to tell me that if I was blind I should be using a cane so other people could tell.
Do I need to put in more effort to compensate for other people? Do I have to rise above other people rudeness when they refuse to be polite or even mildly accommodating?
No, I don't.
I figured that if I was having a conversation with unsolicited suggestions being freely exchanged, that I should offer my own. I told her that she ought to lose weight to make more room for other people and continued on my way.
My mistake. She hadn’t been looking to exchange suggestions, only to tell me what she thought I needed to do. I never was the most socially adept person anyway. She was still screaming when the elevator doors closed.
Thursday, July 5, 2012
Salvage Operation
Dr. Douglas Grod put a "salvage" operation process before me . Grod would replace the deteriorated bones with healthy cadaver bones. Then I would need recovery time, perhaps six months or longer, with some or even most of it in a recuperative nursing home.
Dr. Grod showed me the brace that would support the healing limb and make sure no weight ever pressured the foot after the surgery. The brace looked like an iron latticework, like the skeletal frame of a sewer pipe. The brace would have to be on for up to or even beyond six months and in many ways would be like scaffolding around the leg.
The brace would be attached to the leg via six or more wires or rods that would run directly through my leg for the duration of the healing process. The wires or rods would take any weight from the ankle and foot by transferring it to the metal frame.
I do not refer to the process as "Frankenstein-ish" because of the use of dead peoples’ bones. If I could get dead people’s eyes installed, I would without hesitation and wouldn’t even care if they were the same color as my old ones, or each other. The entire process just seemed too extreme, too much. Not enough potential chance of gain for the amount of risk and discomfort.
When I met with Dr. Grod, I was recovering from the toe infection and a horrific stay at another hospital. I could not see long term residency at a nursing home as a livable option for me, and the risk of infection was a prominent thought. After having a toe abrasion infect and gangrene in under three days, I would have no less than twelve points of metal protruding through my skin for a prolonged period.
If my body were to reject the foreign body parts inserted, they would have to redo the surgery, if replacement cadaver parts were readily available. Without such availability, I would be faced with automatic amputation.
I was never clear what shape my legs would be in compared to each other as cutting off the end of my tibia and doing a bone graft was also part of the process.
This option might have been more favorable if I were a young man who was losing a limb due to a car accident. I carefully considered this procedure before deciding against it. As a diabetic for close to forty years, I have too many other problems and too much risk of developing other problems including too much risk of infection for this risky proposition to seem practical.
I am permanently blind because PRP laser surgery that was supposed to prevent retinapathy caused retinapathy. Should I roll such dice again with the hopes of preventing amputation by doing a "pioneering" procedure that could cause the loss of the limb?
I have taken some big risks in my life, but this limb salvage plan will not number among them.
Dr. Grod showed me the brace that would support the healing limb and make sure no weight ever pressured the foot after the surgery. The brace looked like an iron latticework, like the skeletal frame of a sewer pipe. The brace would have to be on for up to or even beyond six months and in many ways would be like scaffolding around the leg.
The brace would be attached to the leg via six or more wires or rods that would run directly through my leg for the duration of the healing process. The wires or rods would take any weight from the ankle and foot by transferring it to the metal frame.
I do not refer to the process as "Frankenstein-ish" because of the use of dead peoples’ bones. If I could get dead people’s eyes installed, I would without hesitation and wouldn’t even care if they were the same color as my old ones, or each other. The entire process just seemed too extreme, too much. Not enough potential chance of gain for the amount of risk and discomfort.
When I met with Dr. Grod, I was recovering from the toe infection and a horrific stay at another hospital. I could not see long term residency at a nursing home as a livable option for me, and the risk of infection was a prominent thought. After having a toe abrasion infect and gangrene in under three days, I would have no less than twelve points of metal protruding through my skin for a prolonged period.
If my body were to reject the foreign body parts inserted, they would have to redo the surgery, if replacement cadaver parts were readily available. Without such availability, I would be faced with automatic amputation.
I was never clear what shape my legs would be in compared to each other as cutting off the end of my tibia and doing a bone graft was also part of the process.
This option might have been more favorable if I were a young man who was losing a limb due to a car accident. I carefully considered this procedure before deciding against it. As a diabetic for close to forty years, I have too many other problems and too much risk of developing other problems including too much risk of infection for this risky proposition to seem practical.
I am permanently blind because PRP laser surgery that was supposed to prevent retinapathy caused retinapathy. Should I roll such dice again with the hopes of preventing amputation by doing a "pioneering" procedure that could cause the loss of the limb?
I have taken some big risks in my life, but this limb salvage plan will not number among them.
Monday, July 2, 2012
To Build a Better Me
I debated with myself whether or not to name Doctor Douglas Grod outright. I liked him, personally and professionally. I would not hesitate to be treated by him again, if my regular foot doctor, Thomas Mancini, were to be unavailable. Grod had great bedside manner, though my cynical nature cannot separate the routine from the sales pitch. Mancini had recommended Grod because Grod might be willing to do more than any other local foot doctor would. Grod's approved bio indicates this at: http://www.rifootcare.com/douglas-j-glod.html
My hesitation to name him stems entirely that I chose not to go ahead with what Grod could offer. Mancini recommended Grod in large part because, as the site claims, Grod "has been able to pioneer techniques in limb salvage that few in Rhode Island or in the New England area have ventured."
By my experience and in opinion not exclusive to me, "pioneering" can be interpreted as "experimental." To put it in my blunt way that is the precise reason for my hesitation to outright name someone who I did judge to be a good doctor, the process put before me in May 2012 seemed freakishly Frankenstein-ish on more than one level.
My ankle is bad and will never fully recover. The Charcot condition resulted in the loss of bone density while the ankle was too swollen for healthy circulation to be possible. Without good blood flow ushering nutrients where they needed to be, I suffered bone density loss in the center of the ankle.
The chance of success was maybe 50/50. Failure would result in amputation. I give kudos to Dr. Grod for his brutal honesty; he tried to neither hide nor gloss over the risks. Unlike Dr. Dumbass, Dr. Grod did not rely on old X-rays or scans or other doctors’ appraisals of my condition to determine what he could do about it.
For reasons I will make clear in an upcoming post "Salvage Operation," I decided against this procedure.
I do, however, sincerely appreciate the opportunity to have been presented with the option in a fair and informative manner and been allowed to make up my own mind about it.
My hesitation to name him stems entirely that I chose not to go ahead with what Grod could offer. Mancini recommended Grod in large part because, as the site claims, Grod "has been able to pioneer techniques in limb salvage that few in Rhode Island or in the New England area have ventured."
By my experience and in opinion not exclusive to me, "pioneering" can be interpreted as "experimental." To put it in my blunt way that is the precise reason for my hesitation to outright name someone who I did judge to be a good doctor, the process put before me in May 2012 seemed freakishly Frankenstein-ish on more than one level.
My ankle is bad and will never fully recover. The Charcot condition resulted in the loss of bone density while the ankle was too swollen for healthy circulation to be possible. Without good blood flow ushering nutrients where they needed to be, I suffered bone density loss in the center of the ankle.
The chance of success was maybe 50/50. Failure would result in amputation. I give kudos to Dr. Grod for his brutal honesty; he tried to neither hide nor gloss over the risks. Unlike Dr. Dumbass, Dr. Grod did not rely on old X-rays or scans or other doctors’ appraisals of my condition to determine what he could do about it.
For reasons I will make clear in an upcoming post "Salvage Operation," I decided against this procedure.
I do, however, sincerely appreciate the opportunity to have been presented with the option in a fair and informative manner and been allowed to make up my own mind about it.
Friday, June 29, 2012
Feet on Solid Ground
I nay be harsh at times, but I always aim to be fair.
I am so direct and open when dissatisfied with a doctor that I feel a need to post when I encounter a really good one. Dr. Thomas Mancini, with offices in East Greenwich, RI and on Mineral Spring Avenue in North Providence, is one of the good ones.
I do not know (or care) if he is related to the other podiatrist Mancini who has an office on Armistice Boulevard in Pawtucket.
Just as I state why I come to dislike or distrust specific doctors, I want to point out the factors of Mancini’s positive appraisal.
He listens. This can’t be overstated. As a diabetic, I have heard a lot of pop-psychology jargon about needing a "medical team" for my care. In such terms, Mancini would be part of the "team" of which the patient should always be captain and manager. We’ve fully discussed aspects of my foot problems, including the infection and the ongoing Charcot condition. It is also obvious to me that Dr. Mancini had put independent thought into things.
He made himself fully available to me and my roommate when and since things went bad with the toe infection. He has been great in booking timely emergency visits as issues arose.
The foot has been fully inspected with each visit and he has done anything and everything necessary, from the Charcot to the infected toe to routine things.
He has answered any questions I posed rather than become defensive or offended by them. There are darker aspects of my long term prognosis that he stayed quiet about, but he sugar coated nothing when I raised such issues. If anything, he seemed genuinely relieved that I was able to bridge the subjects, which included my belief that it is probably inevitable that, sooner or later, I will lose the right foot below the knee due to the Charcot condition.
Dr. Mancini has no God Complex. He is approachable and knows his own limitations. When the hospitalization for the infection ended, the Charcot condition was much worse. Without hesitation, and without trying to pawn me off on someone else, he recommended me to another foot doc, Douglas Grod to look into treatment beyond what Mancini felt he could do. As it turns out, Mancini was not sold on the ultimate wisdom of doing what Grod could do. The point to me is that even with his unvoiced objection to the potential procedure, Dr. Mancini made the recommendation for me to look further into the situation.
I have seen very little humility like that among doctors, and the entire experience–which is ongoing–makes me recommend Dr. Thomas Mancini above any other foot doctor in Rhode Island, for diabetics or people with other foot problems.
I am so direct and open when dissatisfied with a doctor that I feel a need to post when I encounter a really good one. Dr. Thomas Mancini, with offices in East Greenwich, RI and on Mineral Spring Avenue in North Providence, is one of the good ones.
I do not know (or care) if he is related to the other podiatrist Mancini who has an office on Armistice Boulevard in Pawtucket.
Just as I state why I come to dislike or distrust specific doctors, I want to point out the factors of Mancini’s positive appraisal.
He listens. This can’t be overstated. As a diabetic, I have heard a lot of pop-psychology jargon about needing a "medical team" for my care. In such terms, Mancini would be part of the "team" of which the patient should always be captain and manager. We’ve fully discussed aspects of my foot problems, including the infection and the ongoing Charcot condition. It is also obvious to me that Dr. Mancini had put independent thought into things.
He made himself fully available to me and my roommate when and since things went bad with the toe infection. He has been great in booking timely emergency visits as issues arose.
The foot has been fully inspected with each visit and he has done anything and everything necessary, from the Charcot to the infected toe to routine things.
He has answered any questions I posed rather than become defensive or offended by them. There are darker aspects of my long term prognosis that he stayed quiet about, but he sugar coated nothing when I raised such issues. If anything, he seemed genuinely relieved that I was able to bridge the subjects, which included my belief that it is probably inevitable that, sooner or later, I will lose the right foot below the knee due to the Charcot condition.
Dr. Mancini has no God Complex. He is approachable and knows his own limitations. When the hospitalization for the infection ended, the Charcot condition was much worse. Without hesitation, and without trying to pawn me off on someone else, he recommended me to another foot doc, Douglas Grod to look into treatment beyond what Mancini felt he could do. As it turns out, Mancini was not sold on the ultimate wisdom of doing what Grod could do. The point to me is that even with his unvoiced objection to the potential procedure, Dr. Mancini made the recommendation for me to look further into the situation.
I have seen very little humility like that among doctors, and the entire experience–which is ongoing–makes me recommend Dr. Thomas Mancini above any other foot doctor in Rhode Island, for diabetics or people with other foot problems.
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