Tuesday, July 22, 2008

Cortisone's A Bitch.....And So Am I

Cortisone is a BITCH, pure and simple.

Especially when injected into a joint of a diabetic.


Yesterday morning, I sat on gurney in a darkened room, with an audience consisting of a Radiologist, a nurse, and three attending physicians, (including one from China,) all crowded around an ultrasound watching as the image of my foot went from a grayish hue to reddish orange.

The Radiologist showed me (and my audience,) exactly where my foot was inflamed on the ultrasound, and I knew what was coming next. The one thing that I’d tried so hard to avoid these past 8 months was about to become a reality. Damn Metasalgia! He turned on the lights and started to speak.

Radiologist:“You have severe inflammation of the foot, second metatarsal & ligament. First, I'm going to numb you with lydacane, and then inject you with cortisone in the exact area that’s inflamed. Oh GOODY, I think to myself. I'm going to mark your foot exactly where the injection goes, because we need to be precise as possible, especially when it comes to the metatarsal area.

Now Kelly, are you aware that cortisone can cause elevated blood sugars for the next 7 to 21 days? I also need to make you aware of infections that can occur. Your a diabetic and this is your foot.”

Me: “Yes, I know all about the elevated blood sugars caused by cortisone and I’m totally aware of infection and foot issues for diabetics.”

Radiologist: Before I give you the shot, I need to know how you’ll handle your blood sugars.”

Me: “I’ll test often and keep in contact with my CDE.”

Radiologist: Great. Any sign of infection, I need you to go to a Dr. ASAP.

Me: “No problem. So will this fix me? If it doesn’t work, what’s next? When can I start aerobic activity and resume my longs walks? When can I wear pretty shoes again? When will everything be back to the way it was?”

Radiologist: You need to stay off your foot for a few days, ice it, elevate it, and take Tylenol for the pain. No aspirin for 24 hours. You can’t walk or run a marathon just yet Kelly. You’ll need to ease back into that type of activity, but not for at least 3 weeks, and then, start slow. It takes the cortisone a good 4 to 7 days to actually reduce the inflammation and your foot is really going to hurt for the next week or so.”

Me: “OK, I just want to get better. I take it that strappy peep toed wedges are still off limits until then?”

He didn’t answer me.

He dimmed the lights again and showed my inflamed area on the ultrasound to the audience of attendings. The shot and the pressure of the lydacane and then the cortisone being injected into my joint brought tears to my eyes. I tensed up and tried to be brave.
I continued to breathe deep and waited for it to be over.

When I looked up, one of the attendings, a woman near my age, who had asked me about the insulin pump and my experience with diabetes, looked right into my eyes and told me it would be OK. “Your going to do your 10 mile walks again Kelly.” At that moment, I really needed to hear that.

Thanks," I said and smiled.

I took my blood sugar (139) and increased my basal rate before I left the office.
By the time I drove home, my Blood Sugar was 63. I treated and watched it creep up every hour and adjusted the basal accordingly.

When the lydacane wore off, I could barely apply pressure to my foot, it hurt me more than words can describe. Basically, it felt like I’d stepped on a butter knife, continued walking on said knife, while traipsing over hot coals. I could tell I was in for a long evening of testing, icing, and elevating,
Which I did - religiously. I live on my own, no one to help or watch me. I need to be able to handle this if I want to continue to live an independent life.

By the end of the day, my Basal rate was up to 4.25 units an hour. Normally, my basal rate is between 1 and 1.15 units an hour. My blood sugar was around 199 at 9 p.m, and I raised my basal again to 4.5 units. I woke up with a low of 66 at 6 a.m.

Yesterdays total insulin intake 58 units.
Today’s insulin tally so far: 60.

Normally, my daily insulin total in a 24 hour period is somewhere between 30 and 39 units.

My highest cortisone blood sugar was 245 and my median cortisone blood sugar was 186.Not great, but not terrible, as far as cortisone and it’s diabetes issues are concerned.

When I had trigger finger two and a half years ago and received cortisone, no one at the Dr’s office bothered to tell me that steroids cause severe spikes in blood sugar.
I had to learn the hard way, by blowing close to a 500 BS when I got back home. Which resulted in several infusion set replacements, almost throwing out a new bottle of insulin, and an emergency call to my CDE, who set things straight. I also called the hand surgeons office and threatened to sue, if they didn’t immediately create a document that warned all diabetic patients of cortisones effect on blood sugars, which of course, they did….But I digress...That’s another story for another post.

Back to the whole inflamed foot thing. When I tested at breakfast this morning I was 115.
And At lunch I was 68. I treated and have started to decrease my basal rate, ever so slowly.

The foot feels a bit better, certainly not as tender to pressure as it was last night.
It no longer feels like I’m walking on a knife plunged into my foot while walking over hot coals. THANK GOD.

I’m still monitoring like a hawk stalking prey and I’ve gone through almost two containers of test strips so far.

Tomorrow evening I go to my acupuncturist for the pain. I’ve been going for a month and have seen a huge difference in the pain caused from Metatarsalgia, I wish I had started seeing her sooner.

Diabetes complicates things, but it doesn’t mean that it will win. My Metatarsalgia was not caused by diabetes, (it was actually caused by my love of walking long distances and a nasty toe brake two years ago) but the diabetes certainly didn’t help matters.

Still, the whole thing is teaching me patience on every level, and is reinforcing me to be an active patient in my recovery.

Today, I sit at home working, with my foot elevated and my ice pack near by.
I’m visualizing my first 3 mile walk on Kelly drive, and my first 5 mile walk on the Ventnor /Atlantic City boardwalk. The sun is shining on my face, the wind is blowing my hair, and I’m walking to the beat of my own drum. I can smell the ocean and I smile just thinking about it. I’m also dreaming about strappy wedge heeled, peep toed shoes with my toenails painted red.
I'm looking good and feel great! "FEET DON"T FAIL ME NOW!"

I plan on making the above paragraph a reality in the very near future.

Cortisone may be a bitch, so is Diabetes & Metatarsalgia for that matter. BUT, I got news for you Cortisone; Diabetes, and blasted Metatarsalgia, SO AM I !


Karen said...

Ouch - you poor girl. Ir sounds like you are doing just what you are supposed to and are over the worst of it now though. My thoughts are with you and I hope you are back to "normal" (whatever that's supposed to be) soon!

George said...

I am so sorry you are in pain . That makes me sad. Here's to a speedy recovery!!!

k2 said...

Karen -
THANKS. I just would like normal to be walking pain free, and it will be!

G- Ninja -
Don't cry for me Argentina!
I am going to own this problem, it won't own me. However, I may be bitching from time to time and will need your Ninja Powers on my side!

Scott K. Johnson said...

You go K2! You are tougher than that stuff, and we've all got your back!

Jeff said...

Thinking pain-free thoughts for you, Kelly. I hope you're up & running (or at least walking) again soon.

Donna said...

I hate to hear you're in such pain. But I'm sure you'll be up and about in no time. I hope you have happy feet soon!

k2 said...

Scotty J -
Yes, I'm tough! Just keep reminding me of that fact from time to time, PLEASE!

Jeff -
Thanks for the pain free thoughts, I plan on taking full advantage of them! THANKS.

Donna -
"Having happy feet soon," has now become my mantra!

Cara said...

Let's hope this is all better soon!
I can't imagine the pain. You are a brave, brave person.
Get better soon.

k2 said...

Thanks. I don't think I'm any braver then any other member of dblogville.
"It is what it is" and each of is do what we have to each and every day.

Lora said...

Evidently, we've been reading each other's blogs at the same time...

While I don't like to exercise, I think you're right in that if I COULDN'T do it, I'd miss it.

I feel for you. Especially because I don't consider nice, long walks through pretty places to be exercise. :) That I would definitely miss.

Hang in there. It won't be long before you're moving again. I'm pretty positive you'll make sure of that...

k2 said...

Lora -
I love your blog!
Walk around Chicago and think of me!
Hopefully I'll be able to visit and walk around town myself, very soon!
Continue to ROCK !

CALpumper said...


Ugh. Bitch on girl! hee hee.

Sorry to hear of your latest woes. Ouch and ouch. I think I will take oral surgery over what you endured and continue to any day.

Hang tough Queen! ;-) You'll be back at those long walks soon enough.

Naomi said...

If you didn't say that you were going to an acupuncturist, that would be my first suggestion. Amazing recovery from pain.

Keep that foot elevated & iced! I know you'll be showing off your toe cleavage soon!

k2 said...

CalPumper -
Thanks! Will continue to hang tough!

Acupuncture is a beautiful thing!
Ahhh..,Toe Cleavage, I'm making sure that all my TC shoes are polished and on stand by!

Anonymous said...

That don't ever give up flyer must have come just in time...hang in ther girl.


k2 said...

Betty -
Perfect timing on the flyers
arrival - Thanks again!

Katie I. said...

Kelly, thank GOD the foot troubles will be a thing of the past soon. But that completely sucks about the pain and high bg's! Ugh. I cannot imagine. Thank goodness you know exactly how to deal with it all. At least the pain and high bg's will be worth it in the end, because I know that you've really hated how the Metasalgia has limited you with exercise.