Diabetes Self-Management Blog

“Happy birthday, you old bat!” Terry said (somewhat loudly) as I was waiting for my husband to get the scooter out of the van so I could go meet some friends for lunch. Including Terry, by the way.

It was last Friday and it was, indeed, my birthday. I’m now a couple of rungs up on the “60” ladder. Terry and Sally got me a book. In large print. You think they were trying to tell me something? (You just wait: They’re going to hit 60 in five years or so.)

We were joined by Dorothy, an octogenarian who was leaving from lunch to do a weekend-long program on the “F” word — Feminism.

It’s a great group. We’ve known each other since the 1980’s and our get-togethers are always full of laughter. Laughter is a good thing and I sure need it right about know, with life-altering surgery looming. (If you’re just reading this blog for the first time, about the bottom third of my left leg is being amputated because an infection I’ve had in my heel bone has spread to the rest of my foot and is traveling up my leg.) Luckily, my friends are concerned — but, at the same time, cut me no slack. It’s zings as usual. Not to mention as much disrespect as they can muster.

After lunch, my husband and I went shopping at the medical supply store. Never in my life did I think I would be excited about getting a potty chair! It’s one that can be used stand-alone or set over an existing toilet.

We have a full bath and two half-baths in this house. One of the half-baths is in the basement, so that one is out. Because of its (tiny) size, I won’t be able to get into the half-bath on the main floor using a walker or anything. Ironically, that’s the only one in the house with a raised toilet.

The one I will be able to ride my scooter into, use a walker for, or whatever, just has a normal-height toilet, so that potty chair comes in very handy. Not only does it have a raised seat, it has handrails on either side. No more using the windowsill and toilet paper dispenser!

I already have a transfer seat for the tub/shower, going back to when I had my original surgery, so that’s taken care of.

Your comments have been very helpful. Who knew I would need a bed tray? Bed Bath & Beyond, here I come! (As an explanation, I’m writing this on Monday. My husband and I are going to Indianapolis later today and spending the night. I have to be at the hospital at 7 AM tomorrow — November 16 — with surgery scheduled for 9 AM.)

A picker-upper. Yes! We have a couple here, but my Sweet Baboo only buys things like that on sale, so they aren’t very good. I didn’t know there were better ones out there. He will be opening his checkbook for a top-grade reacher thingy.

I must say something here about baling wire. I was reading that comment when I got to the part about baling wire. Then my husband came to pick me up for lunch. All through lunch I was wondering what baling wire was good for.

So off I go. I plan to wear my “rhymes with witch” socks — er, sock — into surgery. They were a gift from my friend Liz. You have to have a little love and fun with you. I’ll think of all of your thoughts, prayers, and kind wishes.

I plan to have everybody involved in the surgery sign my left leg so they know which one. I know I will undergo some initial therapy, mainly to learn how to transfer from bed to chair, to toilet, etc. I’ll do my physical therapy back home, which will involve a short hospital stay.

OK, then. Gotta go get packing. All of you please take good care of yourselves and I’ll “see” you next week. Hopefully. Depends on how I feel. At any rate, I’ll let you know how I did.

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Comments
  1. Good Luck to you. You are the most positive person I’ve ever heard of. Please let us know how you do…..when you can.

    Posted by Deborah |
  2. Well, Jan, I’m very new to this diabetes thing, and reading the last few posts on your blog have been something of a wakeup call. Hell, this thing really is serious isn’t it?

    I’m in the UK so the times are more than a bit different, but by my calculations if you are anywhere east of the Rockies you should be out of surgery by now - short a whole load of little bones and part of some of the bigger ones. I’m feeling for you - I’m mean that rather literally, in that I’m sitting here trying to imagine how it feels to have half a leg missing. And thinking how much I would rather not go there.

    So, I’m thinking of you, believing that you have the resources to cope with this, and hoping that your medics are all doing their jobs properly.

    I shall watch your blog and hope that you can post that all has gone well (in so far as this can be “well”) in a week or so. Don’t rush it. (People keep saying that to me and I hate it - I’ve other medical problems and I can NO WAY rush it. But you know what I mean.)

    Posted by Vicki |
  3. I am praying for a great outcome from surgery and a great recovery afterwards. I always read your article first and look forward to them. You are one of my most admired women. I always learn so much from you. Looking forward to reading how you are doing. Take care. If you don’t feel like doing your blog next week could we please get an update from someone there?

    Posted by Cathy |
  4. Jan, you should be out of surgery now and even out of the anesthetic world by now. All good thoughts are coming your way from my corner of the country.

    Posted by Cathy A. |
  5. As a long-time friend of Jan, I was able to call her on the afternoon of her surgery. True to her spunky spirit, she answered her cell on the 3rd ring. She was sitting on the edge of the bed, completely coherent, and had just finished a liquid lunch! She is amazing!!!

    Posted by Karen |
  6. Jan, Sure hope all went well for your surgery. Praying for your recovery and hoping to read a post from you soon. :)

    Posted by Janet Green |
  7. Hey y’all

    I am doing well. Even the “discomfort” isn’t as bad as I expected. The hospital is great and the people are awesome.

    My biggest problem is a laptop I’m unfamiliar with. It’s my husband’s.

    I should be able to write a blog next week. Keep those positive thoughts going!

    Jan

    Posted by Jan |
  8. Hey, Friend:

    I can breathe a sigh of relief the initial surgery is done and now the fun of recovery/rehab/whatever. Sometime in the spring we will think of the “Big trip” and at this point consider when we can get to Chicago… pre or post prosthesis?? |

    I have been reading the comments and glad everyone is seeing the side I know. Later,

    SLB

    Posted by SLB |
  9. Hello everyone,

    An update: I spoke with Jan earlier, and she asked that I let all of you know that she’s scheduled to leave the hospital today.

    Sincerely,
    Diane Fennell
    Web Editor

    Posted by Diane Fennell |
  10. Diane Fennell: Am having chemo, surgery and radiation in the coming weeks. Can you send me an article about how this will effect my being a diabetic 2? There has to be others with a similar question but not sure where I can get an anwser on this site.
    Thanks,
    Richard

    Posted by Richard Shaner |
  11. Hello Richard,

    Thank you for your question. We have several resources that you might find helpful. First off, I’ve posted the text of a recent reader question about the chemotherapy drug Sutent (sunitinib) below my signature in this reply. Certain chemotherapy drugs can cause hand-foot syndrome (http://www.chemocare.com/managing/handfoot_syndrome.asp) or peripheral neuropathy (nerve damage); you may want to discuss this with your oncologist and ask what precautions to take if you will be taking one of these medicines.

    For managing diabetes during your post-surgical hospital stay (assuming your surgery will require time in the hospital), you might be interested in reading the following article:

    “What to Expect in the Hospital”
    http://www.diabetesselfmanagement.com/articles/general-diabetes-and-health-issues/what-to-expect-in-the-hospital/

    And if you will be taking any steroids (as part of your chemotherapy regimen, for example), you might want to read Amy Campbell’s piece on how these medicines can affect blood glucose control:

    http://www.diabetesselfmanagement.com/Blog/Amy-Campbell/the_ups_and_downs_of_meds_and_diabetes_part_1_steroids/

    In addition to the resources available from Diabetes Self-Management, I was also able to find several other articles online that address the issue of managing cancer treatments and diabetes. They are as follows:

    Diabetes and Chemotherapy, CancerHelp UK:
    http://cancerhelp.cancerresearchuk.org/about-cancer/cancer-questions/diabetes-and-chemotherapy

    Diabetes & Cancer, MD Anderson Cancer Center:
    http://www.mdanderson.org/patient-and-cancer-information/cancer-information/cancer-topics/dealing-with-cancer-treatment/diabetes/index.html

    Q&A, Diabetes & Cancer, MD Anderson Cancer Center:
    http://www.mdanderson.org/publications/cancerwise/archives/2007-january/cancerwise-january-2007-q-a-diabetes-and-cancer.html

    Be sure to speak with your doctor before making any changes to your diabetes treatment.

    Thank you again for your question, and best of luck with your treatment and recovery.

    All the best,
    Diane Fennell
    Web Editor

    Cancer drug side effect

    Q. I have Type 2 diabetes and will be starting chemotherapy soon for cancer treatment. The drug I’ll be taking is called sunitinib (brand name Sutent). I’ve read that this drug can cause dryness, thickness, cracking, or blistering of the skin on the palms of the hands and the soles of the feet, and I’m very concerned that this could lead to a foot ulcer and the need for an amputation, since I have diabetes. Is this, in fact, likely to happen? And how do I prevent it from happening to me?

    A. Sunitinib is in a class of drugs known as multikinase inhibitors, which suppress certain cell-to-cell signals to stop the growth of tumors. Sunitinib is approved for use in gastrointestinal stromal tumors (GISTs) and renal cell carcinoma (kidney cancer) but it is also used off-label — without specific Food and Drug Administration (FDA) approval — in other cancers and in clinical trials. Multikinase inhibitors can cause many skin changes. In studies of patients with renal cell carcinoma, for example, common side effects included rash, skin discoloration, dry skin, and hand-foot syndrome.

    Hand-foot syndrome, also known as palmar-plantar erythrodysesthesia or PPE, is caused by exposure to chemotherapy drugs and could cause the blistering you have heard about, as well as a red and peeling rash that looks like sunburn. PPE affects the parts of the body where blood tends to pool, such as the hands and feet. The drug may be more likely to leak out of the small blood vessels, or capillaries, there and cause damage to the surrounding skin.

    Within 2–12 days after starting Sutent, you may feel stinging or tingling in your hands and feet. Over a few days, you may develop redness of the palms and soles. Sometimes the reaction stops there, and although it can be painful and interfere with daily activities, it does not always progress to blisters. If blisters do form, the main treatment is proper wound care. This includes inspecting the affected areas daily, washing them with a mild soap and water, wearing cushioned socks and protective shoes, keeping open sores covered with proper dressings, and possibly using an antibiotic ointment or another topical treatment. Of course, the first thing you should do is discuss any symptoms you’re having with your doctor, who may refer you to a dermatologist or wound care specialist. Some studies indicate that prednisone, an oral steroid, can help with the condition.

    Dry skin is another common side effect of this medication. This ranges mild to severe and though it may not cause broken skin, it’s smart to ask ahead of time how you can prevent this and other complications that could endanger your feet. Proper foot care is the key. You should wash your feet with a gentle cleanser like Dove, Cetaphil, or Purpose bar soaps. Bar soaps generally have fewer irritants, like preservatives and fragrances, added to them than liquid soaps. Gentle cleansers will also kill bacteria living on the skin, so you do not need to use an antibacterial soap if your skin is still intact. Avoid harsh soaps like Irish Spring, Dial, Zest, or Ivory. After cleansing, dry your skin thoroughly. Use a towel or a cool hair dryer, and don’t forget to dry the skin between the toes; this is the most common place for fungus or bacteria growth. Next, apply a moisturizer. Plain petroleum jelly (like Vaseline) is a great option — it’s inexpensive, gentle, and provides a barrier to rubbing and other trauma. Other options are Cetaphil or Neutrogena Norwegian Formula hand creams, which contain glycerin and are a little less greasy than petroleum jelly. If you have thick skin on your feet, you may benefit from a keratolyic moisturizer, which helps exfoliate the skin using lactic acid or urea. Amlactin, Keralac, Eucerin, and Gormel work this way.

    Prevention is always best when it comes to keeping your feet healthy during chemotherapy and any other time. If your skin starts to break down, consult your doctor and get care sooner rather than later to avoid complications. Inspect, cleanse, and protect are the steps to healthy feet. (Jennifer Krejci-Manwaring, MD, Assistant Professor of Dermatology, University of Texas Health Science Center at San Antonio)

    Posted by Diane Fennell |

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Foot Care
Getting a Foot Up On Diabetes Care (02/25/14)
Simple Steps Can Reduce Amputation Rate by Half (02/01/13)
Limb Loss Awareness Month (04/05/12)
Peripheral Arterial Disease Underrecognized in Women (03/09/12)

Diabetic Complications
New Approach for Neuropathy Pain? (08/18/14)
Study Evaluating Treatment for Neuropathy Pain (07/08/14)
Good Control Now = Lifetime Benefit (06/25/14)
What You Need to Know About UTIs (03/24/14)

 

 

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