podiatrist | Test Guess and Go

A while back I wrote a post about how I jinx myself when I think things are going well. The mere hint of positive vibes is enough to send my life into a downward spiral. In late January I wrote a post reviewing the book Things You Need to Know About Diabetes and Your Feet by Neil M. Scheffler, DPM, FACFAS. I talked about the importance of foot care along with mentioning (or was it boasting?) that I had no foot problems and had never seen a podiatrist.

Fast forward to two days after that post. I was walking with a friend and out of nowhere started having pain in the back of my right heel. Nothing popped; nothing twisted; it just started hurting. I finished my walk and figured that the pain was minor and would go away. I hobbled around for a few days and continued with most of my regular activities. I iced the foot often and used a topical gel for pain relief. Once or twice when it was really painful, I took a couple of ibuprofen tabs. That is a big no-no for me because I am already on a prescription NSAID for my arthritis. The ibuprofen really helped, but it is safely back in the medicine cabinet. If the pain is so bad that I feel I need it, I should be talking to my doctor and not abusing prescription or over-the-counter medications.

The pain continued to get worse and my next step was to quit all activities except for sitting on the couch and icing the heel regularly. Every so often it seemed as though it was better, but a walk across the room quickly dissuaded me of that notion.

I think that you can guess where this story is going. Suffice it to say that she who had never seen a podiatrist before has now seen a podiatrist.

Call the Podiatrist

Tuesday I went to a foot doctor recommended by a friend and had the heel checked out. Fortunately x-rays ruled out anything like bones spurs and he believes that it is an inflamed nerve. He injected the heel with an anesthetic steroid concoction and I am supposed to go back in two weeks.

The doctor seemed very knowledgeable about my feet. Because of my diabetes he did an extensive visual inspection and checked for pulses and sensation. After asking how long I had had diabetes, he did a little math in his head, and questioned how I could have Type 1 (Juvenile Diabetes) because I had been diagnosed as an adult. Argh! Very nicely I indicated that Type 1 is the result of an autoimmune attack and age of diagnosis has nothing to do with it. End of conversation.

In all of my years with diabetes, this is the first time that I have ever had a steroid injection. I was expecting a huge jump in my blood sugars, but so far the effect has been minor. Initially I used a temporary basal of 130-150% which was similar to what I had used for couch camping. Yesterday I started to go low and returned my basals to normal. Overnight I started to run somewhat high and I have upped my basals again with a few correction boluses. So far the pain relief from the injection has been worth any disruptions in blood sugar.

The first afternoon after the injection was nirvana because the anesthetic was still active and I had no pain. Two days later I can walk normally and that’s a huge improvement. I am still taking it easy and will continue to ice the foot. Abby the Black Lab was thrilled to get a walk around the block yesterday after two weeks of home confinement. I checked with Dr. Google and he/she/it indicated that it usually takes a few days for a steroid injection to take effect and I am optimistic that I will continue to improve.

Have I learned anything from this? Absolutely YES! I think that I have learned to keep my mouth shut. I now realize that blogging is a threat to my health and I should take up a less risky hobby such as sky-diving. When it comes to reviewing books about feet, I’m going to stick to The Foot Book by Dr. Seuss:

Left foot, left foot,

right foot, right

Feet in the morning

feet at night

And that’s all I have to say on the subject.

A few weeks ago on Twitter, I saw a request from the Book Department of the American Diabetes Association for bloggers who might be interested in reading and reviewing books. As someone who enjoys reading and is always looking for blog topics, I jumped at the opportunity. Rather than being assigned a book, I was able to select the book(s) I wanted to review. I decided that I would opt for books that were a bit outside my comfort zone: books that rightly or wrongly I might not normally read. The books that I chose were provided to me free-of-charge, but my reviews, as always, are my own opinions.

My first selection was a short book by Neil M. Scheffler, DPM, FACFAS titled 21 Things You Need to Know About Diabetes and Your Feet.

Why did I pick this book? I chose it because I currently have no issues with my feet related to diabetes and I usually skip the chapter on foot care when reading diabetes books. By selecting this book, I wanted to force myself to read and learn everything that the podiatrist author deemed important. I also wanted to compare his recommendations to what is happening with my care team, my feet, and my diabetes.

The Book

Dr. Scheffler has written a concise guide to just about everything you need to know about having healthy feet and about the specific risks that those of us with diabetes face. Like every other discussion about diabetes and feet, he spells out the grim statistics on the first page and doesn’t take long to start talking about amputations. Fortunately he very quickly moves on to the good news as stated by the Center for Disease Control (CDC) that “comprehensive foot care programs, i.e., those that include risk assessment, foot-care education, and preventive therapy, treatment of foot problems, and referral to specialists, can reduce amputation rates by 45% to 85%.”

The “21 Things” referred to in the title are the 21 chapters of the book. Topics include the Diabetes Foot Care Team, Diabetic Neuropathy, Foot Ulcers, Shoes and Socks, and Emergencies. One thing that I particularly appreciated was the discussion that foot care requirements are not the same for everyone. Kind of a YDFMV (Your Diabetic Foot May Vary) attitude. (Thanks, Bennet of YDMV.) Although the author states that everyone should check their feet daily, he is quick to concede that a recently diagnosed Type 1 in her twenties probably does not have the same needs as someone who is a senior citizen with 20 years of diabetes and numbness in his feet.

My Feet

So how do I measure up with the care of my feet which have carried me through 37 years of Type 1 Diabetes?

I’ll tell you the bad stuff first. By the third paragraph of Chapter 2, I’m already looking at a failing grade. Rather than an annual exam with a foot specialist, I have never seen a podiatrist in my life except for a free 5-minute exam at the ADA Expo in October. I wear sandals and thonged flip-flops frequently. Last year I didn’t go to the doctor for a bloody toe from an extended downhill climb in wet hiking boots. My endocrinologist does not check my feet.

Before you take me into custody for a foot intervention, let me explain myself. My feet have always been in good shape and the last time my endo saw them, she stated that she wished all of her patients had feet as well-cared for as mine. Although many endocrinologists check feet at every visit, the ADA Standards of Care only require an annual comprehensive foot exam that includes checking for pulses and sensation as well as a visual screening. For me that exam is performed at my annual physical by my internist and my endo questions me to ensure that it has been done.

I am fortunate to have no numbness in my feet. I can feel the tiniest grain of sand and quickly respond to shoes or socks causing irritation. I use moisturizing foot creams daily to prevent painful heel cracks. My flip-flops are thick-soled with good arch support and I only wear them at home (okay, also at the beach). I wear high-quality socks such as Thorlo and Smart Wool. When hiking I often put on dry socks at lunchtime and always wear gel protectors (they’re like toe socks) on my second toes to prevent the kind of injury I had last year. I am still agile enough to inspect my feet and clip my nails.

Believe me, I take foot care very seriously even though I don’t follow every rule. I accompanied my father-in-law to many podiatrist appointments for wound care of foot ulcers resulting from Type 2 diabetes and congestive heart failure. One of my friend’s husband with diabetes had a leg amputated a few years ago. I have heard Kelly’s story of her continuing battle to save her foot as she fights various tissue and bone infections. There are others in the DOC who struggle with balance and numbness in their feet.

I’m not stupid. This is serious stuff. Although Dr. Scheffler would wish that I saw a podiatrist, I think that he would approve of how I care for my feet, work on achieving good blood sugars, and very importantly, don’t smoke.

I am getting older and have had diabetes for a long time. Just because I have never had a podiatrist appointment in the past doesn’t mean that I never will in the future. In fact I probably will. And like everything with diabetes, what I do is not necessarily what you should do. Follow your good sense, the advice of your medical team, and take care of your feet.

If you would like to purchase this book or any other books in the American Diabetes Association Store, please go to this link: http://www.shopdiabetes.org/