Tag Archives: Foot Care

IV AB Day 5 – Flying Solo

4 Jul

IMG_0576

 

 

Day 5 saw me flying solo with my IV and self-administering for the first time on my own at home.

Nothing to report.

Everything went to plan and was uneventful.

Which is good.

I made sure that I was on my own so that I had no distractions.

I did take a longer time to set it up than when supervised at the hospital.

Doing this for the first time I guess I checked everything 3-4 times more than needed.

But I do understand that this is serious shit and that getting it wrong could cause me additional issues that could at least be a pain in the arse……

 

Again, this reminded me of my Diabetes diagnosis and the first injection that I did on my own when I got home……

Everything went to plan and was uneventful.

Which was good.

I made sure that I was on my own so that I had no distractions.

I did take a longer time to set it up than when supervised at the hospital.

Doing this for the first time I guess I checked everything 3-4 times more than needed.

 

I think that these are both like driving a car.

You are shown how to drive.

You get behind the wheel under supervision.

You learn and become more confident.

You pass your test and get released into the world to drive on your own.

Your first trips out unsupervised are hesitant and you double-check every move and maneuver.

With experience your confidence builds.

It becomes second nature.

Before you know it, you are driving with the music blaring, your arm out of the window and your feet on the dashboard……….

 

As I carry on with my DIY IV I will get quicker.

It will become second nature.

It will become more familiar.

However, I must ensure that familiarity does not breed contempt.

That it does not lead to mistakes or errors.

 

Live Long and Bolus.

Grumps.

 

Advertisements

IV AB Day 4 – Released into the Wild

1 Jul

The plan for today:

  • Get new cannula (Mid-Line) fitted by DR
  • Set-up own drip again
  • Get dripped (is that a thing?…)
  • Bugger off home for Sunday roast!

Had a longer wait today as I needed to see the Doctor to put in the “Mid-Line” cannula.

Why does it need a Doctor I wondered?…

Well, as I found out, because its fucking long!…..

This is the original Standard cannula. It needs to be changed every 3-5 days. It is also in a bloody annoying and inconvenient place!

uxx0m7NhTcuvWBecstoSuw

Because I will be on IV daily for at least 6 weeks I was offered a “Mid-Line” cannula that can stay in place for at least 3 months. Sounded good to me so I agreed.

When I was called in I was asked to lie on the bed type thing.

The Doctor comes in and tells me about this thing…..

“I will insert it here (pointing at the place my bicep should be) and it will go in your vein up to here (pointing just below my shoulder)”.

“Okay” my mouth said.

“OH FUCK!” my brain whispered….

The Doctor proceeds.

Uses an ultrasound scanner to find the best route.

Unpacks his sterile gown.

Puts a sterile sheet thing with a hole in it over the insertion area (stop sniggering please).

Injects my arm with local anaesthetic (Oh. Numb left hand. Useful…..)

Sticks in a big needle thing.

Feeds in what seems like 123 metes of cannula.

Withdraws inserter (he told me it was a safe method…)

All done!

 

Q45+3OwhRC+F8f9WhUqVew

I have to be honest, this is 100 times more comfortable than the other one.

I can bend my arm ok without catching the cannula.

So even though it was a prolonged procedure it was worth the wait.

After that I set-up my IV as I did yesterday and got my daily dose.

 

Bonus for the day?

I got given everything I need for the next 7 days to do this solo.

I need to go back every Sunday, get my bloods taken and pick up the next week’s supplies.

The guys at my hospital have been fantastic!

The extra time that they have taken in teaching me to do this on my own allows me to continue to live my life how I need to and ultimately earn a living.

So, tomorrow I fly solo.

But that’s another blog post….

Live Long and Bolus

Grumps.

IV AB Day 3 – Under Scrutiny

30 Jun

I’m going to try and keep these short and quite soon I expect them to stop.

Once I’m up and running on my own this will just become part of my daily routine and there will be no story to tell.

So, the plan for today was….

  • Go to Ambulatory Care
  • Prepare my own IV drip, under supervision
  • Get a longer term (up to 3 months) cannula inserted

As soon as I walked in I could see that there were only two staff in and a lot of people waiting for treatment, so I know I’d have a bit of a wait. This is fine with me. People are getting the care and attention that they need so I will never mind waiting my turn.

The nurse calls me in when it’s my turn. “were you hoping to be trained how to do this today as we are short on staff and it takes a long time to do”.

This is not really what I wanted to hear as I’m impatient to get signed off and let loose with IV in the wild.

I explain that the plan was for me to do the setup but I totally understood if it’s not possible. However, I was on the clock a bit with this as ideally, I would be going away for work on Tuesday (3 days’ time). I explained that I have already had the process explained and was ready to try myself.

“Ok, let’s see if you can recall any of the steps with all of this then” …

00dqPAkdTt2c5Lg5r8aA4Q.jpg

Yesterday I found it easy to remember what to do. Having been around syringes, sharps and solutions it had all felt very familiar to me. So, I rattled off the process step by step without hesitation.

“Oh, you did remember well! How do you feel about trying to do it yourself or would you like to be shown a few more times?”

My reply “Well, you won’t let me go it alone with this stuff if I don’t will you? I’ll do it now”

Sudden flash back to the week I was diagnosed almost 24 years ago.

A nurse comes to do my pre-meal injection (syringe back in those days).

“We will show you how to do this as many times as you need and then when you feel ready you can try yourself”.

Grumps – “I’ll do it now please”

Nurse – “Are you sure you are ready?”

Grumps – “Will I you let me out of here until I can do this myself?”

Nurse – “Well. No…..”

Grumps – “Then please pass me that syringe”

Clearly, I haven’t changed in the last 24 years.

I am still a stubborn bastard!

Everything went to plan an I started myself in my very first #DIYIV

fullsizeoutput_973

Unfortunately, there was no Doctor available to do the cannula insertion but that has been moved to tomorrow.

At least it will give me something to write for Day ……..

Live Long and Bolus

Grumps.

Starting on IV – Days 1 &2

29 Jun

I’ve never written a diary.

Nope.

Never.

It’s not really me, is it?

I don’t need to write down my feelings. In fact I try to never have any…..

I don’t really have private thoughts. I tend to spew them about on social media.

However, I have decided to document the next chapter of the treatment of my foot issues on this blog.

Why?

Simple really.

At some point, someone about to start on daily IV antibiotics may stumble across this and it may have some information that helps them along their own journey.

I think of it as possible future peer support……

A short background to all of this.

A foot ulcer that has taken 10 months of treatment so far.

A fantastic team that tailor my care to my needs and life.

A list of old broken bones and trauma that I have no recollection of doing. Clearly alcohol must have been involved at some (or many) point……

So, this week I started the next chapter of this long and at times cheesy (its hard to wash a foot you have to keep dry) story. Before I was lucky enough to go to ADA in Orlando, myself and my team had agreed that the day after I got back I would start a 6-week course of daily IV antibiotics. That due to having to work away, I would be taught to self-administer these so as not to impact my life and importantly my income (no work, no money, no bills paid).

Day 1

Foot clinic first.

The ulcer was looking a bit worse for wear after a week on my feet and all that travel, but the general consensus was that it had fared well and the plan of self-care that we had agreed had worked in the main.

I was also fitted with a new offloading boot. Much more robust than the previous one and it will help aid the healing once the infections (yes, 3 to be exact) in my foot and bone have been banished. Of course, I look like a total knob! However, I managed that with ease even without foot issues so it’s not a problem.

12b0pVfySHOmUGc0d5f40Q

Then, off I hobble to the Ambulatory Care Unit…..

First bit of good news was that they were expecting me and knew all about the need to self-administer.

Day 1 here was easy.

Cannula inserted.

IV drip set up.

30 min later I was on my way home to return on Day 2 for my first bit of instruction.

All that was left to do was to put on the new boot when home (you can’t drive in these things. To be honest you can barely walk in the bloody thing!), make a cup of coffee and over share the whole experience on Social Media…..

Day 2

Off I head to the hospital armed with a pad and pen!

Forcing myself to try and be a grown up always hurts but IV stuff is serious and whist I’m a dick head most of the time, this is the time to not be.

Today I was shown how to mix the antibiotics and set up the drip.

I wrote it all down step by step.

My writing is shit!

I mean, really shit.

So, had to take a bit of time to make sure I could read it later.

It’s a fairly simple process to be honest. The things I have had to do in the last 24 years that Diabetes has been living with me make it all easy to understand and there is no likelihood of me being overwhelmed with is because this just feels like and extension of what I already do….

My biggest challenge was actually to not tell myself “well that’s easy” and switch off my concentration.

With this going straight into my blood stream, I need to focus on infection control (because an infection whilst administering antibiotics for existing infections would really be taking the piss right now).

Anyway, there I am with 20 min on my hands as the drip is started.

Only one thing to do…..

Tweet it all out there…

I am very grateful for everyone’s best wishes that have been received.

For all that have voiced their concerns for me. I appreciate that too.

However, this is me, I am genuinely ok with this and this will have a successful outcome, and…..

You will have to endure endless tweets and posts about it too…

I am fully aware that my “resilience” can be my downfall. I am my own worst enemy at times as I push myself too far to prove to myself that I’m immortal. Not this time though. You don’t get rid of Grumps that easily…….

I’m back at the hospital again tomorrow, but will tell you about that, well, tomorrow.

Live Long and Bolus

Grumps.

Complications? What complications – Gwyneth’s Story

20 Jun

About me

Ok, where did this all begin? It all started on 10 December 1975, a date etched in my memory, the date of my diagnosis of Type 1 diabetes. My mother took me to GP ( with a urine sample) cos I’d been drinking loads. GP didn’t believe her til they tested the sample! She was told to go home and pack me a bag then take me to the children’s ward of the local hospital. So there I was at 10 years old, 15 days before Christmas being admitted to hospital.

So began the education we all know so well from the early days, injection practice with empty syringes into an orange, learning what a hypo feels like. Thankfully I didn’t spend Christmas in hospital that year (that was to come much later) but of course eating habits changed.

Complications

Where do I start? Suppose I should really start with the first complication that occurred, retinopathy. This happened when I was pregnant, I was so anal about BG control that I had slight bleeds in both eyes and as a result laser treatment in both eyes, it was fun trying to get into the relevant position on the machine when you’re 8 months pregnant, not!

That was a minor hiccup, the major stuff (I suppose you could call them major) started happening in 2008. At my annual check in the November, the podiatrist noted I wasn’t picking up some of the pin point tests she was doing so I was referred to a vascular surgeon. April 2009 saw me have an angiogram in my right leg – result was that artery in my ankle was calcified and I was losing circulation. Ok, so now I had to really watch what I was doing. I lasted 5 months when an accident in work (a chair landing on one of my toes) sent me rushing back to hospital ( by this time I had the podiatrist on speed dial). I had to have the toe amputated that September and after a lengthy process of waiting for it to heal, eventually had to have right leg amputated below knee.

So far, so good but there I was thinking it’s happened to one ankle, I wonder how long I’ve got til the other goes. I returned to work in April 2010 and I was coping well, however things took a bit of a turn in August 2011. Nasty swollen, red foot. This resulted in me losing a toe on my left foot and this seemed to be healing well until December 2011 when a 2ndtoe turned black. The date? 19 December, guess who was in hospital that Christmas and New Year? This time having my left leg amputated below knee.

The latest complication happened in January this year (2018), I suffered a heart attack (not realising for a couple of hours that the chest pain wasn’t just indigestion). Rushed with blues and twos to local hospital, straight into the Cardiac Lab where they were successful in inserting 3 stents. Heart issue solved but kidneys threw a hissy fit about the highlighting dye they used in the procedure (kidneys had been working steadily at 30%). This caused admission to HDU, a central line going into neck & dialysis for 5 days.

Coping mechanisms

I’ll be honest sometimes it’s tough but it doesn’t stop me. I’m currently studying with Open University for  BSc (Hons) in Psychology, I’m half way through but I want to use my experiences to help others, whether it be amputees or diabetics. The story of course still isn’t finished, my kidneys currently working at about 19% and my wonderful daughter has volunteered to have tests done to see if she can be a living donor for a kidney. You could say I’m still a work in progress.

Gwyn

Defining Complications

20 Mar

Oxford English Dictionary definitions:-

1) A circumstance that complicates something; a difficulty

2) An involved or confused condition or state

3) A secondary disease or condition aggravating an already existing one.

Synonyms:-

An issue, a complexity, intricacy or convolution.

Origin:-

From Latin “complicare” meaning to fold together.

When people speak of complications in the context of diabetes, there is an unspoken, implicit or inferred presumption that the phrase means only a narrow range of specific conditions ( e.g. Neuropathy, Retinopathy), and the the person with diabetes will have brought about these by their actions or inactions.

In my opinion, all of these presumptions are wrong, but not only that, they are very unhelpful.

Synonyms for presumption include:-

Presupposition, an automatic inference, prejudgment and PREJUDICE.

No wonder the conversations about complications in diabetes produce so much judgment and blame!

So, firstly, I would prefer to talk about the issues, complexities and intricacies of living with diabetes, not complications. And secondly, I want to emphasise that they are NEVER caused deliberately by the person living with the condition, but are simply responses to the combination of disease, genetics, physiology and circumstances that people with diabetes may (emphasise that MAY too) encounter during their life.

Having got all the ground rules established, I’ll now tell you what I think of as the intricacies of living with diabetes after having had the condition for 42 years.

The first thing I associate with having diabetes is always feeling a bit tired. It’s a sort of chronic fatigue, and I believe it’s borne of loss of sleep from nighttime hypos, variation in blood sugar levels that results in biochemistry mutating into a physiological effect, and the niggling nag at the back of your mind all the time that you’ve not done something you should have.

The impact of this amorphous haze of weariness that seems to be permanently present is unsurprisingly a degree of grumpiness. This in turn affects relationships, whether at home or work or with friends, who funnily enough get pretty fed up with your always seeming to be in a bad mood and short tempered. Even the most patient or knowledgable about diabetes make it clear at some point that it’s you, person with diabetes, that is in the wrong. It’s your fault.

First strike, as they say. First blame on you. You’ve failed. You must be doing something wrong otherwise why would you feel so tired all the time.

Wrong. You’re not doing anything wrong. You’re coping with a disease that is ever present, so in many ways you could argue they should see you as permanently “unwell” (although we all want to be as well as we can all the time, so I don’t like this way of thinking). The “grumpiness” is caused by the condition, not by you.

Nevertheless, unless you recognise this, it’s pretty easy to become dispirited, demoralized and think that all your efforts at managing your blood sugars are failing. So why bother.

Impact no 2 of tiredness – “burnout”. You give up trying.

Result? Worse blood sugars, you feel worse, you become even grumpier.

A vicious circle develops which becomes a vortex taking you down into depression.

Another “issue” that is not unknown with diabetes, but is also not recognised as a “complication”.

The feeling of being a burden on others can arise even if you’re lucky enough not to feel tired and grumpy, just from all the things you do simply by handling diabetes:-

You’ll be interested in the carb content of food you’re going to eat, and may have other die try requirements that can accompany having diabetes, like being gluten intolerant, you’ll need to do blood sugar tests that involve pricking your finger, you might need to inject insulin or dig a pump out to bolus. Most people will try hard to avoid having a hypo, and will try to look ahead to anticipate what might go wrong and lead to a situation where low sugar is likely. Sometimes this “anticipating” can lead to obsessive planning, which results in extra food being taken, sometimes considered unnecessary by others, or a reluctance to be spontaneous, so you’re thought of as a “drag”.

All of these actions can produce curiosity or frowns faces, but even if the people you’re with are used to you doing these, you’ll know they are aware and you’ll know you are different from them.

By being “apart” or not fitting in or not “belonging”, some people can feel isolated and develop negative self-esteem.

Then there’s the actual capability test – can you stand up to your peers’ scrutiny and do the sums to work out how much insulin you need, just like they can?

In this context, I was told recently that university researchers (at Glasgow I think) determined that on average a person with Type 1 Diabetes makes 100 extra decisions a day, compared to somebody without diabetes. And at a conference last week, it was stated that other research had found the maths ability of many diabetics is equivalent to that of an 11 year old. So, firstly, don’t feel bad – you have to think more that people who don’t have the condition, and secondly, don’t feel different if maths is a struggle – it seems it is for many of us. I shudder to think what the ability is in the population at large too!

In the UK we are exceptionally lucky to have the NHS which means we don’t pay for insulin and other consumables. I saw a photo today of a till receipt for $807 for 3 vials of

Humalog insulin from an American pharmacy (Walgreens, effectively the US version of Boots)! So we’re lucky and grateful.

However, there can be hidden financial costs even here, with food for low carb diets costing more, hypo treatments like dextrose tablets or lucozade, continuous glucose monitor sensors or flash sensors if you buy them, and the tech kit like smart phones or watches to get the benefit of the readings conveniently. I have developed some neuropathy in my feet, and now find it very hard to know whether a pair of shoes fits well. It therefore takes me a long time to be sure I’m getting a pair that will be comfy and won’t rub, and there’s always a risk I’ll buy a pair only to find after a week that they don’t fit and I need to spend the same again to get the next size up!

All this expenditure mounts up, with some things being prohibitively dear, but how many of them either are pretty much essential or make such a difference we would really miss them? We may not have to pay for medical supplies like insulin, but the burden of finding the money for all the other things that are not explicitly diabetes-related can be substantial, leading to worry, etc. etc.

If you haven’t slit your wrists yet, you’ll be relieved to know I think there’s a silver lining to all these negative aspects – effectively they antonyms to the words I prefer to “complication”.

Firstly, you’re managing the condition, you’re coping with it.

Synonyms for these words are “tackling”, “sorting out”, “contending with”, “facing up to”, “handling”.

These all have positive connotations in people’s minds, being good attributes, associated with traits like courage, determination, perseverance. Bear those in mind. You’ve got all of them.

Secondly, you make a lot of decisions every day. If you have Type 1 Diabetes the anecdote about the research is you make an AVERAGE of 100 extra decisions every day (so some days it might be an extra 150!) compared to other people who don’t have diabetes. (I’m afraid

I have no similar anecdote about research relating to Type 2 Diabetes, but it stands to reason, people with that condition will also be making more decisions than people without diabetes).

This decision making involves getting information, weighing up the options and judging which gives the best outcome. It’s not a knee-jerk choice. That “consideration” process is also considered to be a good attribute, so you’ve got that to accompany your ability to decide (another positive).

When you’ve made a decision, you then have to check to see whether your prediction about the outcome was right. This “monitoring” often involves recording stuff (blood sugar readings for example) over time, and analysing it for patterns.

Depending on what your checking finds, you might have to change what you’re doing in some way, adjusting a temporary basal rate for example.

And you have to do these things all the time, every day, in varying amounts depending on how many curve-balls diabetes throws at you that day. Often you’ll have very little time to make each of these considered choices too, so you have an inherent ability to handle pressure, whether you realise it or not.

Making one decision at a time with a break between each one is perhaps not as impressive as I’ve made it sound. However, from my experience, the decision making frequently has to take account of several factors at once. For example:-

I was intending going for a swim today. I usually do about 45 minutes to cover about 1 km in the pool doing front crawl. I had put in the temporary reduced basal rate for about 30 minutes, about an hour before I was planning to go, and I’d eaten 30 g of carbs. then I go to drive to the pool and the battery is flat.

So, I have to decide what to do to take account of the the temporary basal rate and the extra carbs, now I’m not swimming. Do I put in more insulin to correct, only that will take about an hour to start working by which time my sugar will be high, or do I do alternative exercise? If so, what and for how long?

I chose to go for a walk for about 40 minutes and bolus for the extra carb I had eaten.

Two and a half hours later, I’m now sitting at 4.6 mol/l and likely to need a bit more carb to ensure I don’t go lower before dinner. So, nearly, but not quite!

This is a relatively simple example, but it shows how many factors there are to take into account, and plan for, some before starting out when there’s plenty of time to consider, some requiring decisions on the hoof, and how it’s not always possible to get them all right.

I reckon having to make judgements taking into account multiple factors is more common in diabetes than most people think, so everybody with the condition will almost certainly have done this, probably without recognising it.

This waffle is written from the perspective of somebody with Type 1 diabetes, and I confess I know relatively little in comparison about Type 2. However, I am aware that its causes are complex and not particularly well understood yet.

I’d argue there is no benefit in shaming or blaming people with any type of diabetes as all it is likely to do is to reduce their self-esteem which as I’ve explained earlier is likely to be already under pressure from themselves.

So, I would suggest we focus on the achievements people with diabetes realise every day and please let’s not use the word “complications”!

There are so many issues and complexities folded together with a broken pancreas that to label only a small number of traits, (which are effectively identifiable physiologically), is a gross over-simplification.

Far better to encourage and value the positive attributes from coping with the condition, like the endurance, stamina, and strength of will required to get up each day and every day to deal with it. Any other approach in my opinion is prejudicial to helping the person with diabetes.

Brian’s Story

28 Feb

Let me introduce myself, I’m Brian Black I live in Arizona, United States. So my journey with my Type 1 Diabetes started real late in my life. So it all began about this time eight years ago. My health seemed to Plummet into this terrible abyss. My body began to ache, had no energy to make it through the day. Then one morning when I woke up my foot was swollen and when I step out of bed to walk, I felt something just burst and blood and fluid covered my left foot. I was scared for what had just occurred. So off to the Emergency Room I went. Upon arriving at the hospital. The Triage Nurse ask me why I was there. I showed her my foot. The first words out her mouth was I a Diabetic. My answer to her was no, that I had never been diagnosed. At that point everything seemed be happening very quick. I was taken to a bed and many blood draws began. I was put on a I.V. and Oxygen. Things seemed to getting worse. I started Vomiting fiercely. Then the E.R. Doctor arrived. He began to explain to me, my body was in DKA. My response what was that. So he explained and told I was very sick man with life threatening illness. So I was off to ICU to be monitored continuously throughout the night. The next morning I was moved to a regular room. They had stabilized from Blood Sugars and Oxygen Levels. So this when I meet this Female Doctor of Podiatry. She came to my room to examine my feet. As the examination continued, she began tell me that it wasn’t going to be a good outcome. That most likely I was going to loose several of my toes or even my whole left foot. So the first surgery would be later that day, to debrief the Infection in my foot. The outcome from this surgery was some what encouraging. That there would an Amputation of The Small Toe and the Removal of The Metatarus. I would spend the next 21 days in the Hospital going through two more surgery’s. And countless Blood Test to formulate a Antibiotic Cocktail to kill the Infection that was still causing me problems. So I went home with one less toe and a broken ego and Type One Diabetes’s It took over me several years to come terms and not to blame myself for the Complications that this Disease of Diabetes brings upon us. Everyday I work hard to take care of myself with my Diabetes. So I leave you with this No Blame and No Shame.