Pro Antibiotics

It's been a rough week at Sweetly Voiced.

For those of you following my site infection saga, I am pleased to report that after only one dose of Bactrim DS (a sulfa derivative), the larger area of redness (aka most of my arm) returned to a more normal color.

The heat, the lump, the redness of the area immediately around the site, and the pain and tenderness throughout my arm remain four days later though. I've spent literally hours on the phone between the 3 nurses, 2 clinical specialists, 2 customer service reps, my CDE, etc. I've been chided for not prepping my sites better, encouraged to add this or that pain management topical cream... And I've been driving around town with an ice pack tied to my upper arm with a kitchen towel (which is as ineffective as it sounds). Whether or not it's staph-related remains to be determined, but I think there is no denying it's cellulitis.

I'm not the only one who has been suffering skin woes in this house though. Little Sweetie has had some kind of diaper rash that has persisted for FOUR months. We treated it with rash creams, with benadryl cream, with anti-fungal creams, with cloth diapers and disposable ones, with organic creams and medicinal compounds. We changed detergents, I took mental notes about her diet, I put vinegar in the bathwater, I bleached my cloth diapers, we changed her bath soap and lotion, we dried her more carefully, etc.

Two months ago, her pediatrician said that she might just be a rashy kid and would deal with this until she was potty trained. I wasn't willing to give up so easily and continued through the litany of treatments above. And, through it all, any time she could get her diaper off, she'd scratch. It obviously itched.

My husband finally said that, if it was bothering me so much, I should take her to my dermatologist.

I took her in on Tuesday, described my epic battle of mommy vs rash, and he had me take the diaper off. One look at her and he declared that it was folliculitis - a bacterial infection causing the itching and the bumps throughout the entire diaper region and down her legs, and he prescribed...that's right - Bactrim. And a topical cream called Desonide.

Within 24 hours, her skin looked almost normal. It's odd to see the cheeks of her bottom look like a commercial baby's rather than a teenager with an acne breakout. Her skin is white again, rather than irritated and pink.

I'm relieved, but I'm also frustrated and angry that she suffered so long. The two doctors and two nurse pracs at this pediatric practice should have seen this for what it was, should have tried more treatments, shouldn't have left her to itch. And I should have trusted my mommy instincts enough to drag her to a specialist months ago. This situation only furthers my distrust of general physicians' expertise.

And - speak of the devil - I have an appointment in the morning with my general practitioner to look at my arm again before we go into the weekend. I'll try to be cooperative, but I imagine I'll just attempt to boss him around.

Fire Arms

As we returned from Boston last Saturday morning on a very early flight, I was still hoping to make it to our local north Dallas JDRF Walk. In anticipation of chatting up folks at the Omnipod table, I placed a brand new pod on the back of my right arm where it would be visible to anyone interested. A conversation starter, I thought.

By the time we arrived in Dallas, were bussed to our car in the remote parking, picked up our other car so we could go separate directions, etc, etc, I had missed the walk entirely. Oh well, second missed year in a row. Last year to rain. This year to travel delays.

But I had a brand new pod on that should take me through to Tuesday morning.

By Monday morning, however, it was clear that my blood sugars were being obstinant. No matter how I bolused, I hovered between 160 and 210 on my Dexcom CGMS. I bolused over 13 units for lunch and decided to wait to eat until I was trending downward. An hour later, I was still in the same place. Weird, I thought.

By Monday afternoon around 2pm as I began my afternoon music lessons, I felt a little pinch in the back of my arm.

By 6:30pm, as my last student headed out the door, I yanked the unbearably painful pod out and felt horribly sick. It hurt to move or touch my arm. The pod blurped out a few drops of insulin. Hmm. It's not supposed to do that when you remove it, I thought to myself. I popped open a new vial of insulin and inserted a new pod elsewhere on my body.

Checked urine for ketones. Got the horrible end-of-the-spectrum dark purple color. Oh no.

And my arm? A picture is worth a thousand words.

It was on fire. Ice packs did nothing (except for quickly warm to room temperature). A hard lump larger than a half dollar rested below the insertion wound. Lying on my arm or even lifting my arm above my head sent a shock of pain through my whole body.

Two days later? No change.

I called my GP's office and went in for an exam this afternoon. I held an ice pack on it with one hand as I handled the steering wheel with the other hand the whole way there. Got to the office and the ice pack was warm. My arm felt hot to the touch still.

He removed a tiny scab I hadn't even seen and inspected the insertion point with tweezers to make sure that there were no cannula remnants, he lanced it to check for fluid, but neither effort resulted in an answer. He prescribed oral antibiotics, encouraged me to keep icing it, and said he'll see my back on Friday to see if I'm responding to the antibiotic.

When I left there, I started making a lot of phone calls to people I trust at the local level who work for Insulet - the company that makes the Omnipod. They were nearly as baffled. Site infections don't normally hurt. And the redness in the picture above, though not streaking, was certainly spreading across the back of my arm - which is also out of the ordinary. The GP measured it at well over 10cm across.

But the two clinical specialists from Insulet were in complete agreement that it was a site infection, possibly staph related (particularly since I had a staph infection with another brand of pump four years ago), and that oral antibiotics were critical. They also pointed out that if you have staph once, you are  at risk as a carrier forever, and that if I am not doing any significant skin preparation pre-insertion, I'm posing extra risks to myself by exposing the insertion site to whatever happens to be on my skin. Point well-taken. Guilty as charged.

I filled my scrip, tied an ice pack onto my arm with a dish towel, and went about the rest of my evening. Hoping to see it start to subside soon.

Diabetes Art Day, 2011

Today marks the 2nd annual Diabetes Art Day: a web-based initiative for the Diabetes Online Community to “tell a story” about life with diabetes though creative visual expression.

I decided to tell my story using some of my supplies and a few of Sweetie's toys - particularly the 12 numbers from her Melissa & Doug Clock.

Keep on Ticking...

Breakdown:

1 Time DKA (at diagnosis, in a coma)
2 Years on the Omnipod
3 Years in the Diabetes Online Community (DOC) - note the toy cupcake
4 CGMS Sensors per Month
5 Shots a Day on Injections
6 Pumps in 21 Years
7 Days a Week I Volunteer with TuDiabetes.org
8 Minimum Times I Test Blood Sugar per Day
9 Bottles of Insulin Every 90 Days
10 Age at Diagnosis (That's me in July of 1990.)
11 Boxes of Strips Every 90 Days
12 Months of Blogging