M18 G17 R4
X1 Q3

He who comes in peace

After a week with 2 to 3 times daily application of topical antibiotic (Mupirocin 2%) and keeping the wound uncovered (dry),  the wound is finally healing up.  I got some more insulin yesterday, and have started drinking diet green tea.  The wound seemed to improve even more since yesterday.  Keeping the foot elevated helps, keeping the blood sugars down definitely helps (the redness tends to expand with my blood sugar value).  I also exercise on a bike 1 mile every day, and a few hours later take a hot bath in water that contains a high sulfur content.  The bath really helps the foot wound to look better.  It really seems almost medicinal in value – I think because of the mineral content.  Both activities vasodilate the feet.  The swelling in the foot increases and recedes as a function of elevation, largely.  Swelling must compress both the vasculature and nerves, because when swollen there is very little sensation in the foot.  Obviously, this becomes problematic for getting anything that would fight infection into the area.  I’m anticipating that the wound will close by Thursday or Friday of this week.  At this point, I’m guessing that there will be swelling that remains both from tissue damage and maybe latent uncleared internal infection.  Perhaps, exercise, weight loss, and salt reduction will help to get the rest of the swelling out once closed.  Otherwise, the foot may have to be imaged, and/or antibiotics administered orally if the swelling begins to worsen.

At its worst (a lot of sitting) the foot looks like this (day 25 after injury) :

100_3159Swelling is notable, and causes me to walk unevenly in the right sandal because the foot doesn’t fit all the way in there with swelling.  For 1 week now, I have maintained the foot without any rubbing from contact with shoes or socks.

100_3158During moments like this, I tend to look internally for solutions.  The topical antibiotic really made a difference.

There are entire books written on this subject, but I found this paper, that for the most part, was too depressing to read.  The pictures are really horrific looking.  I’m pretty sure my wound is almost healed, so I’m not going to panic.  There is some basic strategy to be gained from my experience, and a take-home message to really try to get my blood sugars and weight under better control.  A lot of the intro of this paper justifies panic and expense, but I really think I have this one under control.

There are some scientific arguments out there for both the green tea effect, and the sulfur effect.  In the end, healing is an art.  Years of experience with diabetes and you learn to figure out whether something is working or not, and to think through a problem.

I drank a whole gallon of diet green tea in 24 hours.  25-35 mg/cup of EGCG.  It comes to about 1/2 a gram.  They use 100 uM EGCG on exponentially growing keratinocytes in the paper.  I got about 150 uM from my green tea intake, if I assumed that none of EGCG decayed, was excreted, or absorbed by anything, and that my keratinocytes were bathed in this concentration due to perfect circulation.  None of that is probably true, but it’s worth the calculation anyway.

A nice little skin test (100% in 54.5s)

A little harder skin test (88% 1st time, 100% 3rd)

A neat little movie that shows how the process is supposed to happen.

And I took the MCATs 2X.  The first time I walked in cold, without ever having seen the exam, and barely passed.  The second time I studied, and pulled a respectable 37.  Still, I can’t imagine having to focus on the same problem everyday in 15 min increments and look at pictures like in the paper.  There would probably have needed to be a different kind of socialization to medical education, and a more diverse outcome for it to have been a match for me.  It doesn’t mean I wouldn’t have been great at it.

Some Arabic: I note the word for mouth “fam” might be related to famine, the words for eyes “eyen” (same in Hebrew) and ears “oudon” (ozen in Hebrew) also seem related: les yeux, Augen, ojos and les oreilles, Ohren, orejas.  The Arabic and Hebrew way of first person possession (my) is the same with “i”.  It is interesting that German and English both have different words for toes and fingers: Zehe und Fingern.  French and Spanish follow the Arabic example with doigts de pied and dedos del pie corresponding to isba (etsba in Hebrew) and isba al qadam (etsba hargel). The word for foot seems pretty unique.  Belly (bat’n) and legs (rigel) are very close in Hebrew and Arabic.  Hand is the same (yad).

Everything spelled out in Arabic.

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