The Loss
October 21, 2015 7:20 AM Subscribe
Oh my ... never mind, no snark, this give me chills, logging out now and going for a long walk.
If you can, walk more, if it's a problem, get help and do more walking. Not soon, not later this week, now and every day. Braces, crutches, pain meds, what ever, walk and keep walking.
posted by sammyo at 8:16 AM on October 21, 2015 [5 favorites]
If you can, walk more, if it's a problem, get help and do more walking. Not soon, not later this week, now and every day. Braces, crutches, pain meds, what ever, walk and keep walking.
posted by sammyo at 8:16 AM on October 21, 2015 [5 favorites]
This is likely the future for my dad. For years he ignored the signs of uncontrolled diabetes -- likely due to him drinking far too much -- and only a stroke forced him (actually, mom forced him) to finally see a doctor and get on some medication. His doctors are battling vision problems and he's got significant peripheral neuropathy in his feet.
I say "his doctors" because he himself is doing very little. It's extremely frustrating for us all to watch. I have no doubt that some amputations are in his future.
posted by sbutler at 8:18 AM on October 21, 2015 [1 favorite]
I say "his doctors" because he himself is doing very little. It's extremely frustrating for us all to watch. I have no doubt that some amputations are in his future.
posted by sbutler at 8:18 AM on October 21, 2015 [1 favorite]
A family friend of my husband's recently killed herself because she was about to lose both of her hands. She had already lost both of her feet. Diabetes aint nothing to fuck with.
posted by LizBoBiz at 8:23 AM on October 21, 2015 [1 favorite]
posted by LizBoBiz at 8:23 AM on October 21, 2015 [1 favorite]
This is horrifying. I was just lamenting the fact that I'd cut back on exercise due to a thyroid problem over the past year, and after reading this, I'm highly motivated to re-establish my regular cardio routine (60-90 minutes daily, 7x per week).
And... 1 in 200 Americans are amputees? From TFA:
HOLY. SHIT.
posted by Unicorn on the cob at 8:45 AM on October 21, 2015 [1 favorite]
And... 1 in 200 Americans are amputees? From TFA:
Fact No. 1: In the US, roughly one out of every 200 people has undergone primary (above or below-knee) amputation, according to the National Limb Loss Info Center: 45 percent due to trauma (unseen trains, for example), 54 percent due to peripheral arterial disease1, and 1 percent other.So, what, as an American, I'm 5x more likely to experience limb amputation as die in a car accident? (10.3 deaths per 100,000 car accidents, or 1 death per 1,000 accidents on average across all 50 US states)
HOLY. SHIT.
posted by Unicorn on the cob at 8:45 AM on October 21, 2015 [1 favorite]
I think I've said this before somewhere but diabetes is one of the most horrific diseases in terms of its morbidity and mortality. That Type 2 diabetes is considered a relatively benign condition in the eyes of the public (the "beetus") is a huge hurdle for American physicians to overcome when counseling patients about health and diet.
posted by ghostpony at 8:47 AM on October 21, 2015 [6 favorites]
posted by ghostpony at 8:47 AM on October 21, 2015 [6 favorites]
This is ghastly. I am encouraged, though, by the doctors in the article who are talking about implicit bias. Medical schools are also starting to get serious about bias issues in their profession. I know several students who began med school with no real conception of the ways that could affect their work, but who now give mini lectures on the topic whenever things like weight, race, income inequality come up in conversation. They may still be parroting their professors and the articles they've read, but they also talk about trying to account for bias in their actual interactions with patients.
posted by congen at 8:49 AM on October 21, 2015 [2 favorites]
posted by congen at 8:49 AM on October 21, 2015 [2 favorites]
What really pisses me off about this, is that it's not like there's no treatment. Even if the doctor's biases are unconscious, if you're a good doctor, a blocked leg artery due to complications from obesity, diabetes, and/or smoking once diagnosed are the same for every patient, so why would you ever, EVER recommend amputation for someone when you might recommend a CTO procedure for another?
They should ALL have a shot at the CTO procedure. Even if, as a doctor, they don't think the patient will follow-up with after care. The only other option is cutting someone's leg off! I just....arrgg...
(I know that some patients don't show up for treatment until it's far too late, but I don't think that's even close to most patients)
posted by sharp pointy objects at 9:11 AM on October 21, 2015 [1 favorite]
They should ALL have a shot at the CTO procedure. Even if, as a doctor, they don't think the patient will follow-up with after care. The only other option is cutting someone's leg off! I just....arrgg...
(I know that some patients don't show up for treatment until it's far too late, but I don't think that's even close to most patients)
posted by sharp pointy objects at 9:11 AM on October 21, 2015 [1 favorite]
I'm "pre-diabetic" though at this rate I'm probably actually diabetic. I am very bad. I'm a sugar addict. I fucking LOVE sugar.
I am supposed to take my Metformin and I don't. And I should really get my ass on it. I don't like the lethargic feeling I get, the stupid feeling, the brain dead feeling.
But I also don't like the side effects of being obese. I don't like being out of breath. I do worry about neuropathy. I don't have any symptoms now, but I know in the future it's a danger, and I had a scare when I had some rough skin on my foot.
Maybe this post is the wake-up call I need to take it more seriously. It doesn't fucking help when I don't have health care and can't afford it (THANKS OBAMA), nor can I even GET on it if i wanted to, because of limited entry times.
But ultimately that's a side-issue, because the responsibility to take care of myself in ways that aren't medicine related are contingent upon me and my self-control (or lack thereof). I mean, yes, I do have a problem with how our society deals with sugar and believe we need a much more systemic solution, but in terms of my immediate life and what's possible/probable/desirable, that comes down to my choices, and those choices have not been good).
My grandma had diabetes, both my parents do. I think my grandma had some bad side effects, my folks seem to manage it somewhat well with medicine, I think. But I'm not my parents.
Why does sugar have to taste so good?
posted by symbioid at 9:59 AM on October 21, 2015 [3 favorites]
I am supposed to take my Metformin and I don't. And I should really get my ass on it. I don't like the lethargic feeling I get, the stupid feeling, the brain dead feeling.
But I also don't like the side effects of being obese. I don't like being out of breath. I do worry about neuropathy. I don't have any symptoms now, but I know in the future it's a danger, and I had a scare when I had some rough skin on my foot.
Maybe this post is the wake-up call I need to take it more seriously. It doesn't fucking help when I don't have health care and can't afford it (THANKS OBAMA), nor can I even GET on it if i wanted to, because of limited entry times.
But ultimately that's a side-issue, because the responsibility to take care of myself in ways that aren't medicine related are contingent upon me and my self-control (or lack thereof). I mean, yes, I do have a problem with how our society deals with sugar and believe we need a much more systemic solution, but in terms of my immediate life and what's possible/probable/desirable, that comes down to my choices, and those choices have not been good).
My grandma had diabetes, both my parents do. I think my grandma had some bad side effects, my folks seem to manage it somewhat well with medicine, I think. But I'm not my parents.
Why does sugar have to taste so good?
posted by symbioid at 9:59 AM on October 21, 2015 [3 favorites]
Even those of us who do take it need reminders and wakeup calls. Take your metformin.
If it doesn't work/isn't enough, you may end up with injectable insulin.
Compared to that, metformin is cheap and easy.
If the regular stuff is too difficult for your digestive system, ask for the extended release metformin.
I work on computers all day for a living, and come home and mess about on computers. I don't wanna lose my fingers.
posted by Mad_Carew at 10:22 AM on October 21, 2015 [2 favorites]
If it doesn't work/isn't enough, you may end up with injectable insulin.
Compared to that, metformin is cheap and easy.
If the regular stuff is too difficult for your digestive system, ask for the extended release metformin.
I work on computers all day for a living, and come home and mess about on computers. I don't wanna lose my fingers.
posted by Mad_Carew at 10:22 AM on October 21, 2015 [2 favorites]
By the time my granddad died he had lost both legs above the knee. I was really little so I don't remember what it was that finally ended up killing him but I definitely remember how miserable he was.
posted by poffin boffin at 10:37 AM on October 21, 2015
posted by poffin boffin at 10:37 AM on October 21, 2015
The article is correct that this is an extremely important issue that is only growing in importance.
However, I couldn't help but feel a disservice was done by the author's breathless tone (after amputation you can't even kneel to pray! Where's your God now???). I think it's telling that the only clinicians interviewed for the piece were vascular surgeons, who an attending recently characterized to me as "eternal optimists," in the sense that they are usually the last member of the care team to agree it's time to amputate. For someone who spends most of their career performing procedures meant to prevent amputations, it is easy to understand how amputation can become an evil procedure.
To quote an article I found while trying to process the FPP:
Whether it could have been "preventable" through better diabetes care, addiction treatment, etc in the past is no longer significant to the patient whose body has already reached the point of requiring amputation. We may hope to prevent other patients from undergoing major surgery in the future through earlier interventions, but characterizing some amputations as "good" (war heroes, kids with sarcoma) and some as "bad" (non-compliant diabetics) serves no one except the docs who are uncomfortable with what they do.
posted by telegraph at 10:46 AM on October 21, 2015 [4 favorites]
However, I couldn't help but feel a disservice was done by the author's breathless tone (after amputation you can't even kneel to pray! Where's your God now???). I think it's telling that the only clinicians interviewed for the piece were vascular surgeons, who an attending recently characterized to me as "eternal optimists," in the sense that they are usually the last member of the care team to agree it's time to amputate. For someone who spends most of their career performing procedures meant to prevent amputations, it is easy to understand how amputation can become an evil procedure.
To quote an article I found while trying to process the FPP:
"I try to remind my patients that amputation isn't necessarily a failure," Smith says. Without doubt, it is a painful, emotional surgery that involves cutting and removing everything from tissue and bone to muscle and nerves, but it doesn't have to be viewed as an end.I believe healthcare providers do patients a tremendous disservice when we take it upon ourselves to imbue medical procedures with emotional significance. If an amputation is warranted (and I understand that the FPP article raises some very valid concerns about determining when that is truly the case), how is a patient supposed to reconcile their feelings about it, their understanding that they are receiving appropriate care, and the emotions of a physician who believes it's a horrific disfigurement?
When Guedes has to perform an amputation on one of his patients, he tells them that although the procedure may appear to be the final act of losing a limb, it can be a new beginning. "I let them know that we are starting something new, not just losing the limb," says Guedes, who estimates that he has performed more than 1,500 amputations (primarily lower limb) during his 30 years as an orthopedic surgeon.
Fisk agrees, saying that although many vascular surgeons view amputation as a final step because the patient's circulation is unable to be improved, the procedure is not failure. "It's a part of the rehabilitation process," he says.
"Amputation has this terrifying association with disfigurement and impairment," Hurwitz says. "It doesn't have to be that way. Every reconstructive procedure is not a failure. It's a new beginning if the limb can't be salvaged. Many can do much better with an amputation. Once the pain is gone and they start using the limb, they can see benefits quickly."
Whether it could have been "preventable" through better diabetes care, addiction treatment, etc in the past is no longer significant to the patient whose body has already reached the point of requiring amputation. We may hope to prevent other patients from undergoing major surgery in the future through earlier interventions, but characterizing some amputations as "good" (war heroes, kids with sarcoma) and some as "bad" (non-compliant diabetics) serves no one except the docs who are uncomfortable with what they do.
posted by telegraph at 10:46 AM on October 21, 2015 [4 favorites]
Why does sugar have to taste so good?
It doesn't. You can make sugar taste too sweet.
What's the worst thing you do, probably a drink. Sweetened coffee or sugar soda? Cut the sugar out sloooooowly. If it's soda you cut with plain soda water a little tiny measured bit at a time. Keep adding soda to your mix, gradually. When it starts to taste too watery, add lemon juice a tiny tiny bit. Keep dwindling and letting your palate adjust and tackling the next worst thing. Don't replace sugar with no-cal sweetener; you want to break up with sweet itself, not just caloric sweet. Kill your sweet tooth by starving it, but slowly slowly, by incremental taperings. Do this slowly and steadily over months and months with every simple carbohydrate, not just the sweet-tasting ones but the pasty, sleep-inducing ones (potatoesricebreadpasta). Taper slowly slowly down and then off. Meanwhile eat as much fat in as many delectable forms as you like so you don't feel hungry. When you're well and truly off of all of carbohydrate, add fruit back in. Dopamine essplosion. Worth the deprivation and it won't kill you if you keep it sparing, eat the whole fruit, and eat fat and protein with it. Juicy, fibrous fruit, not so much bananas, moreso oranges berries.
Then you "maintain." Tomato sauce is a "sometimes" food. Spaghetti is a "never the hell again" food. Once you're off it, I know you can't believe this now but once you're off it, you're going to be toward noodles like this: "I don't get it. Why did I ever? Why was I eating paste?" Same with, like, the grocery store cake and danish that are ubiquitous in every office. Convenience store candy. Pretzels. Every shitquality consumptionunit carbohydrate crapsnack I used to drive to the store in the middle of the night to get, basically, lost its hold over me and never regained it, and you, too, I betcha.
If you're like me you probably won't ever become indifferent to bread, because bread is the best thing humans ever invented. But you will be able to resist it for the most part. The best part is, if you quit eating bread most of the time, when you do eat a sandwich, it's so insanely good your head explodes. Better than cake, better than chocolate, as good as sex, almost as good as sleep.
Better than every other reason to quit sugar is this reason: because once you're off it, you can use it, deliberately, like a drug. Like the best drug ever. Carbohydrate is not like heroin: once you're off it, you can do a little bump now and again and get right back on track. That alone is reason to quit it: because it feels SO GOOD once you've kicked it to have a little nip of it. Even if kicking it weren't indicated for health and quality of life reasons, it would be worth it to quit because the brainfireworks from special once-in-a-while carbohydrate are unmatched.
posted by Don Pepino at 11:09 AM on October 21, 2015 [14 favorites]
It doesn't. You can make sugar taste too sweet.
What's the worst thing you do, probably a drink. Sweetened coffee or sugar soda? Cut the sugar out sloooooowly. If it's soda you cut with plain soda water a little tiny measured bit at a time. Keep adding soda to your mix, gradually. When it starts to taste too watery, add lemon juice a tiny tiny bit. Keep dwindling and letting your palate adjust and tackling the next worst thing. Don't replace sugar with no-cal sweetener; you want to break up with sweet itself, not just caloric sweet. Kill your sweet tooth by starving it, but slowly slowly, by incremental taperings. Do this slowly and steadily over months and months with every simple carbohydrate, not just the sweet-tasting ones but the pasty, sleep-inducing ones (potatoesricebreadpasta). Taper slowly slowly down and then off. Meanwhile eat as much fat in as many delectable forms as you like so you don't feel hungry. When you're well and truly off of all of carbohydrate, add fruit back in. Dopamine essplosion. Worth the deprivation and it won't kill you if you keep it sparing, eat the whole fruit, and eat fat and protein with it. Juicy, fibrous fruit, not so much bananas, moreso oranges berries.
Then you "maintain." Tomato sauce is a "sometimes" food. Spaghetti is a "never the hell again" food. Once you're off it, I know you can't believe this now but once you're off it, you're going to be toward noodles like this: "I don't get it. Why did I ever? Why was I eating paste?" Same with, like, the grocery store cake and danish that are ubiquitous in every office. Convenience store candy. Pretzels. Every shitquality consumptionunit carbohydrate crapsnack I used to drive to the store in the middle of the night to get, basically, lost its hold over me and never regained it, and you, too, I betcha.
If you're like me you probably won't ever become indifferent to bread, because bread is the best thing humans ever invented. But you will be able to resist it for the most part. The best part is, if you quit eating bread most of the time, when you do eat a sandwich, it's so insanely good your head explodes. Better than cake, better than chocolate, as good as sex, almost as good as sleep.
Better than every other reason to quit sugar is this reason: because once you're off it, you can use it, deliberately, like a drug. Like the best drug ever. Carbohydrate is not like heroin: once you're off it, you can do a little bump now and again and get right back on track. That alone is reason to quit it: because it feels SO GOOD once you've kicked it to have a little nip of it. Even if kicking it weren't indicated for health and quality of life reasons, it would be worth it to quit because the brainfireworks from special once-in-a-while carbohydrate are unmatched.
posted by Don Pepino at 11:09 AM on October 21, 2015 [14 favorites]
What Don Pepino said with one exception: If you can make yourself do it, going cold turkey works better than you would realize. When I went low-carb I was eating to a glucose meter and went through over 200 test strips figuring out what was safe, and there's nothing like seeing that 220 to let you know you just poisoned yourself so DON'T DO THAT AGAIN. The first couple of weeks were a minefield of constant temptation, but then during the third week I woke up one morning with no cravings at all. Stared down a donut with the realization that I really didn't want it all that much any more, and off to the races.
The reason you can bump it as DP suggests is that if you do eat a treat you get the rush, but you only get the cravings back if you start eating carbs habitually again.
posted by Bringer Tom at 12:06 PM on October 21, 2015 [3 favorites]
The reason you can bump it as DP suggests is that if you do eat a treat you get the rush, but you only get the cravings back if you start eating carbs habitually again.
posted by Bringer Tom at 12:06 PM on October 21, 2015 [3 favorites]
If it doesn't work/isn't enough, you may end up with injectable insulin.
Compared to that, metformin is cheap and easy.
THIS. Metformin is like three bucks for a month's worth and the negative side effects wear off after a while. Insulin is hundreds of dollars a month off insurance, and dozens on it, plus the pens, plus dealing more with test strips and lancets and it's a GIGANTIC HASSLE. (It is not normally painful, but it is sometimes; sometimes it bleeds, sometimes it forms hard lumps, and sometimes it winds up spraying in the air instead of going into your body when you remove the needle. And you have to keep it cool, which is a hassle for travel and special events. And you're supposed to take it a certain amount of time in advance of a meal, which is a hassle every single time you go out to eat or don't know how long a meal will take to cook or anything really.)
So watch your diet, get some excercise and take the damned metformin. If you can stop it getting worse now, do it.
And keep in mind, it's not just the obvious "sugar" that is an issue. It's carbs. I can't eat a piece of plain wheat toast for breakfast without my blood sugar rising, even with my regular insulin dose.
posted by Foosnark at 1:17 PM on October 21, 2015 [5 favorites]
Compared to that, metformin is cheap and easy.
THIS. Metformin is like three bucks for a month's worth and the negative side effects wear off after a while. Insulin is hundreds of dollars a month off insurance, and dozens on it, plus the pens, plus dealing more with test strips and lancets and it's a GIGANTIC HASSLE. (It is not normally painful, but it is sometimes; sometimes it bleeds, sometimes it forms hard lumps, and sometimes it winds up spraying in the air instead of going into your body when you remove the needle. And you have to keep it cool, which is a hassle for travel and special events. And you're supposed to take it a certain amount of time in advance of a meal, which is a hassle every single time you go out to eat or don't know how long a meal will take to cook or anything really.)
So watch your diet, get some excercise and take the damned metformin. If you can stop it getting worse now, do it.
And keep in mind, it's not just the obvious "sugar" that is an issue. It's carbs. I can't eat a piece of plain wheat toast for breakfast without my blood sugar rising, even with my regular insulin dose.
posted by Foosnark at 1:17 PM on October 21, 2015 [5 favorites]
Since we are sharing anecdotes about quitting sugar, carbs, etc. I'll jump in, because my experience has been very different. I gave up all sugar cold-turkey in February of 2014 because I had moved from "pre-diabetic" to "diabetic." I gave up carbs as well and, while I have those rarely, I try to make sure if I do, it is a small amount and I try to go with something that is "whole" not processed and which contains no added sugar. I am a maniac for reading labels now. I am keeping my blood sugar between 85--100 with just diet. Even so I have neuropathy in my feet and last December had a small wound on my big toe that, despite medically supervised care, got badly infected and required hospitalization with I.V. antibiotics to clear.
I miss sugar every day. I crave it, I day-dream about it, I think about what I would eat if I "went off the wagon."
The only way I cope is by realizing that I am an addict just like any other. As such, I cannot have even the smallest amount lest it trigger a binge. Then I remind myself of the horrible consequences of not keeping my blood sugar under control and I soldier on.
However, when anyone asks me if it is worth it, I always say, "It sucks, but yes!"
posted by agatha_magatha at 1:26 PM on October 21, 2015 [2 favorites]
I miss sugar every day. I crave it, I day-dream about it, I think about what I would eat if I "went off the wagon."
The only way I cope is by realizing that I am an addict just like any other. As such, I cannot have even the smallest amount lest it trigger a binge. Then I remind myself of the horrible consequences of not keeping my blood sugar under control and I soldier on.
However, when anyone asks me if it is worth it, I always say, "It sucks, but yes!"
posted by agatha_magatha at 1:26 PM on October 21, 2015 [2 favorites]
The greatest thing (well, there were so many, but one I remember) was, we had this sweet old guy in the department who would come around every Tuesday with a bag of those mass-produced powdered donut horrors, knowmtalkinbout, the "Sweet Sixteen?" That come in a white paper sack with a celophane window so that you can peep in at them where they're commingling soul-lessly in their paper sarcophagus? That when you subject them to mastication immediately dry up all your spit and explode into their component parts and you're left with a mouthful of flour and confectioner's sugar and preservatives because those horrible little things are so unimaginably dry and lifeless and godawfully chokingly bad? how could anyone, having tried one, ever in a million years try another one?
Well, when I started there I'd look forward to Tuesdays because of The Donut--and the sweet old guy, of course. Sometimes he'd bring those horrible little pecan pinwheels instead, and at the time that was very exciting to me. I'd sit there and chat with him while enjoying my delicious treat got for me specially from the store at the Kangaroo gas station on the elderly sweetheart's weekly jaunt back to his old stomping grounds.
Then while I was trying to boot Coca Cola (I used to drink it every single day; my friend and I called it The Elixir of Life) and pasta, I started to dread Tuesdays because... The Donut. I didn't want to hurt the old dude's feelings and say no, so I'd take The Donut but not eat it and then throw it away after he left. I'd have to sneak it all the way out of my office because of the chance that I if I threw it in my own trashcan I might lose my willpower and spelunk for it.
Then after Coke got too sweet--and I promise you it does, I couldn't drink "The Elixir of Life" today to save my life because it is vile--I'd look forward to Tuesdays again because of the sweet old guy and The Donut. After we finished our chat and he hobbled off down the hall to administer The Donut to the coworker next door, I got to do gleeful violence to those horrible little powderbombs or their sorry limp pals the pinwheels, and then hurl them with extreme prejudice into the trash. It gave me great joy all Tuesday long when I'd glance over and see them in my trashcan, mangled and abused and powerless over me at last after all my life.
Bad snacks have no dominion over you. See the vampire horror donut for the foul, vile trickster that it is. Let the scales fall at last from your eyes and cast it out, out, OUT, yea, lo, away from among you and into the outer darkness, the wailing and the gnashing of no teeth ever, you powdery little bitch, that's right you're going straight into the trashcan in the office bathroom! Begone, begone forever, demon Sweet Sixteen!
posted by Don Pepino at 1:33 PM on October 21, 2015 [4 favorites]
Well, when I started there I'd look forward to Tuesdays because of The Donut--and the sweet old guy, of course. Sometimes he'd bring those horrible little pecan pinwheels instead, and at the time that was very exciting to me. I'd sit there and chat with him while enjoying my delicious treat got for me specially from the store at the Kangaroo gas station on the elderly sweetheart's weekly jaunt back to his old stomping grounds.
Then while I was trying to boot Coca Cola (I used to drink it every single day; my friend and I called it The Elixir of Life) and pasta, I started to dread Tuesdays because... The Donut. I didn't want to hurt the old dude's feelings and say no, so I'd take The Donut but not eat it and then throw it away after he left. I'd have to sneak it all the way out of my office because of the chance that I if I threw it in my own trashcan I might lose my willpower and spelunk for it.
Then after Coke got too sweet--and I promise you it does, I couldn't drink "The Elixir of Life" today to save my life because it is vile--I'd look forward to Tuesdays again because of the sweet old guy and The Donut. After we finished our chat and he hobbled off down the hall to administer The Donut to the coworker next door, I got to do gleeful violence to those horrible little powderbombs or their sorry limp pals the pinwheels, and then hurl them with extreme prejudice into the trash. It gave me great joy all Tuesday long when I'd glance over and see them in my trashcan, mangled and abused and powerless over me at last after all my life.
Bad snacks have no dominion over you. See the vampire horror donut for the foul, vile trickster that it is. Let the scales fall at last from your eyes and cast it out, out, OUT, yea, lo, away from among you and into the outer darkness, the wailing and the gnashing of no teeth ever, you powdery little bitch, that's right you're going straight into the trashcan in the office bathroom! Begone, begone forever, demon Sweet Sixteen!
posted by Don Pepino at 1:33 PM on October 21, 2015 [4 favorites]
why would you ever, EVER recommend amputation for someone when you might recommend a CTO procedure for another?
There has to be a target to plasty (a specific narrowing that you think you can widen). If it's just narrow all the way down, or if the whole vessel is blocked, there's nothing to actually treat. In that case you would try treatments like tablets that open up the blood vessels, and aspirin/statins/stopping smoking/good diabetic control to slow the speed of further damage. The problem then is if the foot gets infected - you need a good blood supply for tissue to heal, and without that you get chronic infection that takes months and months of antibiotics to clear, if it ever clears at all (antibiotics get to the infection via the bloodstream).
You only get an amputation if the foot is beyond salvage (either raging infection, or just already dead) - no vascular surgeon thinks "no foot pulses -> I'll whip the leg off". It's actually really hard for us to convince them to do a definitive amputation on our patients (instead of "nibbling" the dead bits off bit by bit) even when we think that an amputation would be the quickest way of getting the patient free of sepsis and back to a normal life. Amputation is the treatment of last resort, precisely because it is so disabling. You do need to cut back to living tissue though, or it won't heal. So sometimes you can get away with just taking part of the foot off, but sometimes you actually can't.
Having watched plenty of patients who were not fit for surgery die slow lingering painful deaths from infected foot ulcers (and taking several months to do it, which they spent bedbound and stuck in hospital on antibiotics), an amputation is absolutely not the worst option out there. Most patients are keen to have the leg off by the time they get to that stage.
posted by tinkletown at 3:44 PM on October 21, 2015 [1 favorite]
There has to be a target to plasty (a specific narrowing that you think you can widen). If it's just narrow all the way down, or if the whole vessel is blocked, there's nothing to actually treat. In that case you would try treatments like tablets that open up the blood vessels, and aspirin/statins/stopping smoking/good diabetic control to slow the speed of further damage. The problem then is if the foot gets infected - you need a good blood supply for tissue to heal, and without that you get chronic infection that takes months and months of antibiotics to clear, if it ever clears at all (antibiotics get to the infection via the bloodstream).
You only get an amputation if the foot is beyond salvage (either raging infection, or just already dead) - no vascular surgeon thinks "no foot pulses -> I'll whip the leg off". It's actually really hard for us to convince them to do a definitive amputation on our patients (instead of "nibbling" the dead bits off bit by bit) even when we think that an amputation would be the quickest way of getting the patient free of sepsis and back to a normal life. Amputation is the treatment of last resort, precisely because it is so disabling. You do need to cut back to living tissue though, or it won't heal. So sometimes you can get away with just taking part of the foot off, but sometimes you actually can't.
Having watched plenty of patients who were not fit for surgery die slow lingering painful deaths from infected foot ulcers (and taking several months to do it, which they spent bedbound and stuck in hospital on antibiotics), an amputation is absolutely not the worst option out there. Most patients are keen to have the leg off by the time they get to that stage.
posted by tinkletown at 3:44 PM on October 21, 2015 [1 favorite]
That Type 2 diabetes is considered a relatively benign condition in the eyes of the public (the "beetus") is a huge hurdle for American physicians to overcome when counseling patients about health and diet.
A big wakeup call for me (dad has T2DM and I had a fasting sugar of 102 at the time, not dangerous but not normal) was reading the blog of a South African surgeon, where he mentioned that based on the comorbidities he sees in his patient population, he would choose HIV over diabetes in a blue minute.
I go back and forth on how compliant I am with the diet and exercise. Right now I'm in a compliant period, tons of exercise (3 miles of hilly walking + 45 minutes to an hour + weightlifting 5-7 times a week), no sugar or starch except very occasionally. I feel great, I've lost 30 pounds in 3.5 months, my post-prandial blood sugar was 97 on my last reading, I fucking SLEEP again (I have terrible insomnia issues), I have energy, it's wonderful.
Will I keep it up? I don't know. I mean, I have a thousand reasons to stick to this and only one ("bread") not to. The lurking threat of insomnia helps a lot, as do extremely short term goals like "I want to feel not like ass at 3:00 PM." But honest, what probably helps the most is that I have Figure 1 installed on my phone, and every day a dozen new images of the complications of unmanaged diabetes crop up and suddenly the prospect of a grilled cheese sandwich just doesn't seem quite so worth it.
posted by KathrynT at 6:21 PM on October 21, 2015 [3 favorites]
A big wakeup call for me (dad has T2DM and I had a fasting sugar of 102 at the time, not dangerous but not normal) was reading the blog of a South African surgeon, where he mentioned that based on the comorbidities he sees in his patient population, he would choose HIV over diabetes in a blue minute.
I go back and forth on how compliant I am with the diet and exercise. Right now I'm in a compliant period, tons of exercise (3 miles of hilly walking + 45 minutes to an hour + weightlifting 5-7 times a week), no sugar or starch except very occasionally. I feel great, I've lost 30 pounds in 3.5 months, my post-prandial blood sugar was 97 on my last reading, I fucking SLEEP again (I have terrible insomnia issues), I have energy, it's wonderful.
Will I keep it up? I don't know. I mean, I have a thousand reasons to stick to this and only one ("bread") not to. The lurking threat of insomnia helps a lot, as do extremely short term goals like "I want to feel not like ass at 3:00 PM." But honest, what probably helps the most is that I have Figure 1 installed on my phone, and every day a dozen new images of the complications of unmanaged diabetes crop up and suddenly the prospect of a grilled cheese sandwich just doesn't seem quite so worth it.
posted by KathrynT at 6:21 PM on October 21, 2015 [3 favorites]
I think I mentioned this before but it bears repeating, R and NpH are like $25 a bottle at the Wal*Mart. I know they are a horrible company to their employees, the communities where they exist, the environment, and to every company that wants to sell their goods through them, but when it's the pharmaceutical companies they're fucking over I'll gleefully buy there. The fact that the next best place I found charges $140 for the same bottle doesn't hurt. Also, you don't need a prescription there to buy insulin. It may vary by state but afaik the prescription drug act specifically excluded insulin and syringes when it was passed back in the twicketies. At least in Florida, my DL has "insulin dependent" printed in red to indicate that, yes, I do actually need this to live. The prescription-exemption unfortunately doesn't apply to the newer insulins that the endocrinologists will all want to get you on but if you're without decent insurance or your bottle broke/went bad and they won't cover a bridge-fill or whatever this will at least keep you alive.
But if you're a type II or prediabetic, don't let it get that far. Just don't. Take it from a type I, if not your doctor or family.
posted by mcrandello at 10:18 PM on October 21, 2015
But if you're a type II or prediabetic, don't let it get that far. Just don't. Take it from a type I, if not your doctor or family.
posted by mcrandello at 10:18 PM on October 21, 2015
I always get tears in my eyes when I read here in the comments how lack of health-care is a factor. How can you let the Republicans get away with this, when every other civilized country, and some uncivilized countries have fixed this?
That said, earlier this year, my doctor told me I had a slightly too high blood-sugar level, and I should do something. Since my indulgence is too much fatty food rather than sugar, I had to find a solution other than cutting down on sugar, and I started walking - like sammyo said. It's genius. 10.000 steps a day, and your symptoms will be gone (at least at my level), more than 10.000 steps, everything else gets better too.
(I also cut down on fats, but I don't do that nearly as rigorously as walk, because I feed people who are underweight and it's difficult to have two agendas at once in your kitchen)
When I'm stressed, I fall back, and problems rearise.
posted by mumimor at 11:57 AM on October 27, 2015
That said, earlier this year, my doctor told me I had a slightly too high blood-sugar level, and I should do something. Since my indulgence is too much fatty food rather than sugar, I had to find a solution other than cutting down on sugar, and I started walking - like sammyo said. It's genius. 10.000 steps a day, and your symptoms will be gone (at least at my level), more than 10.000 steps, everything else gets better too.
(I also cut down on fats, but I don't do that nearly as rigorously as walk, because I feed people who are underweight and it's difficult to have two agendas at once in your kitchen)
When I'm stressed, I fall back, and problems rearise.
posted by mumimor at 11:57 AM on October 27, 2015
« Older "All kids in the future wear their pants inside... | This is not a women's issue. Don't try to make it... Newer »
This thread has been archived and is closed to new comments
He had diabetes, had trouble with circulation in his foot. He goes in they do an arteriogram. They discover that he has 3 of his 4 heart valves blocked. Well crap, suddenly the foot is no longer primary concern. So he has triple bypass(I think that's what they did for the blockages? anyway, surgery) and comes out in pretty good health.
BUT, because of that they weren't able to operate on his legs. Flash forward the required months after the surgery to where they can operate and he has developed Gangrene in one of his legs. So they amputate, and it gets infected. So they amputate a bit more, and don't take enough, so they amputate. After I believe the 3rd or 4th amputation, he dies.
I would like to add that this was all done at a hospital, but at one that I consider one of the worst.
posted by Twain Device at 7:36 AM on October 21, 2015