Saturday, July 05, 2008

Having worked in the medical field for over twenty-two years, being on the receiving end of medical treatment I am most definitely a self-confessed, lousy patient.
When they are sick, laypeople are usually the best patients simply due to their naiveté.

Roughly five years ago, while living in China, I began to notice some of the symptoms of diabetes, beginning with a poor healing wound on my right lower leg due to an Asian tattoo or muffler burn from a motorcycle taxi I had been riding. The next indication was a sudden numbness in my right upper thigh that I experienced during my first year living in Thailand. Next came intermittent numbness and tingling in my fingers and an occasional sweet smell from my urine. Then, about two months ago, I began to have a sudden onset of vision changes including blurring and difficulty focusing.

All these symptoms are indicative of Type II or “Adult onset diabetes,” however, being the lousy patient I am, I chose to ignore my symptoms until recently when I fell down the stairs in our house and suffered two deep cuts on my left lower leg.

My wounds appeared to be healing well but while Mam was in Chum Phae visiting with her family during Songkran festival, my wounds suddenly became increasingly inflamed and swollen. When she returned two weeks later I asked her to go to the local pharmacy and tell them I had a wound infection and needed some sterile dressings and decent antibiotics.

The pharmacist gave Mam a weeks supply of Cipro®, some sterile gauze dressings, and some Betadine® antibacterial solution. Luckily, here in Thailand you don’t have to visit a physician to obtain a prescription for antibiotics, so treatment of infections or other conditions requiring antibiotics is very cheap and easily obtained.

I took the antibiotic two times a day for five days and carefully changed my wound dressings twice a day. Eventually my wounds began to improve with a reduction of the swelling and less inflammation. About a week later Mam received the untimely news that her uncle had passed away during his stay in a Bangkok hospital for cancer treatment, so she had to fly back to Chum Phae for his funeral. She had been gone about a week when my wounds began to progressively worsen to the point of tissue necrosis and intense pain. I knew I needed to get to the hospital, but due to my lack of communicable Thai, I chose to wait for Mam to return.

She returned on a Saturday afternoon, looked at my left lower leg in horror, and within a couple of hours arranged for a neighbor to drive us to Rajyindee Hospital in Hat Yai since I was in no condition to walk very far.

Once we arrived at the hospital I was immediately whisked into the emergency room where a physician told me I would be admitted and would have to undergo immediate surgery for débridement of my leg wound. He then ordered the nurse to give me a most wonderful syringe full of glorious liquid via my I.V. tubing, sending me into unbridled, pain-free bliss, which changed my outlook on life in general, for the better, for at least the next four or five hours until I began to return to real life again and had to plead for more of the golden liquid.

That evening, around 7 p.m., I was taken to the operating room. I received spinal anesthesia, turning the lower two thirds of my body into an imperceptible bag of sand, had more glorious golden liquid pumped into my veins, and was returned to my room after only thirty minutes of surgery and a short period of recovery. My surgeon told me afterwards that he had to remove a sizeable portion of dead tissue from my left lower leg wound and also confirmed from blood tests that I had type II diabetes, which was the major cause of my poor wound healing.

This is a picture of my leg wound during one of my dressing changes after surgery. The nurse changing my dressing thought it rather odd that I would want a picture of my wound and she appeared a bit unnerved about it, possibly thinking I was taking pictures for legal evidence. I didn’t bother to try and inform her it was only for my blog posting, since I was pretty sure she would have thought of me as rather insane.

Mam, my own personal “Rock of Gibraltar,” stayed with me every day and night, sleeping on a cot provided by the hospital, right next to me and only left the hospital to return home for a couple of hours to feed and water our animals. While at the hospital she occupied her time taking pictures with our new camera and chatting with other patients, their families, and the medical staff on our Medical / Surgical floor.

This is one of Mam’s pictures of a beautiful sunrise taken off the small porch attached to the rear of our private hospital room.

Mam took this picture on the same day, from the same location in the late afternoon, showing the southeastern portion of Hat Yai including the large sign for Tesco Lotus Department Store to the left, a local Buddhist temple shrine in the middle of the picture, and Songklanagarind Hospital to the right, against the backdrop of the majestic mountain range in Hat Yai.

During my hospitalization I was assigned two physicians, the surgeon who debrided my wound and an internal medicine physician who managed my diabetes.

Normal blood sugar levels typically range from 80 to 120 deciliters per milliliter (Depending on individual laboratory specs) in a person without diabetes.

My initial blood sugar upon admission to the hospital was 328 dl/ml.

A wee bit high.

High blood sugar in a type II diabetic such as myself is due primarily to the pancreas failing to produce enough insulin. Insulin is a hormone that functions in the regulation and metabolism of carbohydrates (sugars, starches, etc.) fats, and proteins.

Basically, insulin is the key that unlocks the doors in bodily cells to allow sugar to enter and become metabolized (broken down to produce life sustainable energy). So, if you have a severe insufficiency of insulin (Type I diabetes) or a mild insufficiency of insulin (Type II diabetes) your body isn’t getting the energy it needs, roughly speaking.

In my case, (Type II diabetes) my condition can be managed by taking oral hypoglycemic pills, managing my blood sugar levels by sticking to a regimented low calorie and low fat diet, or a combination of both. Currently, my blood sugar is being regulated by both methods.

Taking pills is easy but sticking to a low fat low calorie diet, for me, is utter hell on earth.

My diet while in the hospital was bland, virtually tasteless and barely tolerable. Not to mention the fact that the dietary staff had very little experience in cooking for a foreigner.

My first breakfast consisted of a bowl of soupy, semi-solid, porridge-like barf-olla that smelled strongly of fish and even had fish chunks swimming in it. I poked, sniffed, and prodded at it while making the most disgusting-looking face I could muster when Mam grew impatient and told me what it was in Thai, which naturally made no sense to me.

“I can’t eat anything for breakfast that even remotely smells like fish,” I told her. (A bit of a white lie since I’ve eaten cold, stale pizza smothered in anchovies in the wee hours of the morning many, many times during my early to late teens.)
So, my wonderful wife scarfed up my breakfast while I partook in a couple bags of complimentary potato chips that were in my greeting basket located in the hospital room, along with a can of pineapple juice and a can of mango juice located in our small, in-room refrigerator.

Lunch wasn’t much better and dinner was unspeakable.

It only took two or three days of this before I conned (sweet-talked, coaxed, soft-soaped, cajoled, wheedled, buttered-up) Mam into taking a short stroll over to Diana Shopping Mall (Actually visible from the south wing of the hospital) to purchase a small, infinitesimal amount of real healthy food from:

Pizza Hut and Kentucky Fried Chicken.

In particular:
A large, supreme pan pizza (thick crust, hold the pineapple), an order of garlic bread smothered… uh, slightly laced with butter, garlic, and thick, melted, mozzarella cheese. Six pieces of deep fried…uh, lightly broiled, spicy chicken pieces with natural, organic, non-denominational, thin, cosmopolitan potato slices of the “super-size” category, lightly seasoned with uh, organic sea salt. Along with various, naturally low-calorie, cardboard flavored complimentary condiments.

Now I was happy.

But, my Internal Medicine physician was not happy. He could not, for the life of him, understand why my blood sugar had gone through the roof, after eating such low-fat, low-calorie foods as the hospitals dietary department was providing for me.

Damned if I knew.

“Have you been eating foods other than what the dietary department is providing?” He asked me.

“The hospital dietary department is trying very hard to try and satisfy my taste for foods common to foreigners, and I am trying very hard to comply with their efforts,” I weakly responded, being partly truthful, and obviously not answering his question.
Luckily, he did not pursue his inquiry or I would have had to fess-up to partaking of the quasi-healthful, curiously nutritional, inconsistently caloric, and delectable food I had been consuming on the sly.

I played this cat and mouse game with him infrequently since I quickly worked out the hospitals schedule for fasting blood sugar tests and cheated accordingly. But in the bitter end I came to realize that it was in my best interest to fulfill my proper dietary prescription if I wanted my leg to heal properly.

My boredom while being hospitalized so long was broken by being able to watch True Visions cable T.V. I quite literally ate up Star Movies on a daily, if not hourly basis. I also received a surprise visit by two of my students who discovered I was in the hospital room adjacent to their father who was hospitalized due to having surgery for an inguinal hernia. Here is a picture of one of them, the boy, whose sister was a bit camera shy.

Finally, I was able to convince both my physicians that I was ready to go home after two weeks and two days, most of which my health insurance covered except for 89 baht, the equivalent of a little more than two dollars U.S., due to my consumption of the two bags of complimentary chips and two cans of fruit juice in my room.

Try and beat that with your local HMO plan!

I’m back to work now and recovering fairly well. However, I still have a sizeable wound on my left lower leg, the lower portion of which still has about a nickel sized area of exposed bone. I dress my wound everyday, twice a day and take my medication religiously, hoping to see improvement soon.

I have a standing appointment with my surgeon every Saturday morning and he examines and evaluates my wound site, mostly telling me things are looking good, but stressing that the exposed bone will have to be covered with tissue until he can further predict whether or not I will need to have a skin graft or not. But beyond that, I’m optimistic since I have no more leg numbness, no numbness and tingling in my fingers, no sweet smell to my urine, and my vision problems have greatly improved.

-Diabetic Jeeem-


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