I've just been communicating with a friend of 30 years on another of the net's pieces of social networking software and as I thought about my next blog concerning the prodding, poking and prescribing to which I was subjected at the hospital on Friday (see the earlier blog "as time goes by" dear reader, for the forward reference), it struck me that that exchange, or at least my side of it, would provide some useful insights at this point. First the hospital story and then the communication. And yes, there are nearly 400 songs about sugar, the title of any of which could have been the title for this blog, which is about my struggle with sugar.
I have been walking in the Subhash Park here in Kochi for about and hour just about every morning, and a great place it is to meet some of the city's finest citizens, as I have reported in some of my earlier missives. My purpose in doing so, combined with watching my diet (although I still watch the occasional packet of crisps also), is to be able to return to Australia in the future looking more like the guy I was 17 years ago when I started in management education (weighing in at 80kg, instead of the 122kg I had been as heavy as until the end of last year when I decided it was seriously time to do something about it). The good news here is that, standing on the scales at the hospital on Friday, I weighed in at 102kg! Only the other half to go now!
Anyway, it was last Monday in the shower after one such walk that I looked down (I can see my toes these days) and was horrified to be looking at the blackened nails of the second toes on each foot, combined with a rather nasty looking blood blister on the second toe of my left foot. I had been conscious of the "pins and needles" I have been experiencing for some time (the result of peripheral neuritis, a common subsequent pathology associated with diabetes) but was shocked to see the state of my feet at that moment. I had sought a referral to a podiatrist from my KIBS boss (who is also an ENT specialist) but he insisted I consult first with a physician and so it was that I finished up at the hospital on Friday morning, with Raju kindly shepherding me through the process.
I expected a quick (well as quick as you can be in India) inspection by the doctor and a recommendation to buy a better pair of joggers for the walk. Instead, my visit to the physician was only the beginning of what took up a fair chunk of the rest of the day. I should mention first that every part of the day was paid for, in advance of whatever procedure or consultation I was party to - very different to the consultation/procedure first then pay (persish the thought that you would actually be sent an account). Each of the payments is in brackets () in the relevant paragraph, so that you can play along. For the non-numerate among you, the total day's expenditure is provided at the end.
First, the physician an MRCP (Member of the Royal College of Physicians) who did his time in London, Glasgow and Edinburgh (INR200). An extremely thorough and precise man, who took a good detailed history and physical examination (my blood pressure continues to be a pleasing 120/80, a perfectly normal reading), his primary concern was not with my feet though. Rather it was my "obesity". Well, yes, I'm fat but even the Sydney doctors were far too polite to describe me in such a bald way. He concluded that, in addition to my "obesity" (which he listed as part of my diagnosis), it was likely I had peripheral neuropathy as consequence of my diabetes and he referred me to his colleague, a Diabetologist (no, I'm not making this up) located in the room next to him. He asked to be kept informed at each stage in the diagnostic and treatment process and "directed" that I should return to him so that we could properly address the underlying problem of the obesity (as he talked about this he poked and prodded my various chunks of fat around chest and stomach and explained that the equivalent amount of visceral fat was interfering with the good working of my organs; yes, yes, thanks, thanks - the truth hurts, I thought).
Second the Diabetologist (with a variety of letters after his name, including WHO (World Health Organisation) accreditation), who introduced himself as Johny (INR150). A cursory examination and it was time for a series of blood and urine tests (INR710, including payment for the disposable equipment used during the procedures - syringe and vacutte). A neuropathy assessment (INR110) and vascular assessment (INR165) completed the battery of tests at this point and it was off to lunch and back to the office for an hour or so as we waited for the various results to come back.
Returning to Johny at 4.00pm he concluded that yes, I have peripheral neuropathy (aka "diabetic foot"), for which there would be medicines and more tests. Note at this point that neither my physician or diabetologist sought further payment for the second consultations (unlike their Sydney equivalents, who like to be paid to tell you the results). So, on the basis that there is the neuropathy, with some fungal component he thought, and possibly some infection to be prevented, the prescription comprised Augmentin (broad spectrum antibiotic, 14 tabs @ INR37.87, being INR530.18), CA GLA-M capsules (Gamma Linoleic Acid with Methylcobalamin (VitB12), 14 capsules @ INR9.50, being INR 133), a tube of Metrogyl Gel (anti-fungal gel @ INR10.61) and Syscan (another anti fungal drug, 1 capsule @ INR41).
Next Wednesday morning at 8.30am, I am also lined up for a fasting blood sugar, a Doppler (ultra sonography) scan of both sets of leg arteries), a 2hr post-prandial (after food) blood glucose (at 10.30am, assuming I get some nosh at 8.30am). I will bring with me to the hospital a big container of my urine collected over the previous 24 hours (try and lug that round discretely!). These guys are determined to make sure that I am properly poked, prodded and prescribed.
Oh yes, for the numerically challenged among you, the bill so far is INR2235 (oh yeah, at the current exchange rate, that's $AUD62.20, or $US56.85, or GBP27.20, or Euro38.75)
And so to my side of the social networking conversation:
"I guess we have indeed been acquainted with each other without really "knowing" each other for a long time, although, in fairness to both of us, one doesn't go about the place saying 'Hi there, my name's David and I'm a diabetic'.
Type II diabetes was diagnosed about four years ago and for the first couple of years was less under control as I struggled with a variety of additional stressors at the time.
One of the reasons for choosing the veg option was related to my concern about the meat. So far my stable alimentary tract has affirmed the reasonableness of that decision (but with the consequences I've already described as far as the sugars are concerned). Generally, one is safe with both chicken and fish and so I am reintroducing these to the diet (I would love to eat salads, of course, but they're all washed in "the water" and that's the end of that - I have also been scrupulous in only drinking bottled water).
So yesterday I tucked into a chicken biryani for lunch and last night was chilli gobi (cauliflower) and chilli chicken, with chappathi - yum! I enjoyed being a carnivore again and, again, I think it highlights the good sense of everything in moderation. I'm off to Phoenix on Wednesday for the Decision Sciences Institute annual conference and a couple of days in Mumbai on the way back to Kochi, so will look for an opportunity to stock up on my allocation of salads during that time."
Off to the Kochi backwaters now! Pictures to follow in the next blog.
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