Saturday, July 31, 2010

Commerce in Diabetes



As laid down in the previous blog i posted, our family was a victim of diabetes. And still a victim to it. During the crisis time when my mom was at the stage of gathering all thoughts she could why she suffered such an illness, I was also at a point of wondering how the world of diabetes rotates. Indeed, a very wide thinking is necessary to be able to put all imaginations into 3D effect flashing right infront of myself, well-sectioned into different lines of thinking. Back then, my thought was running through the the profession involved in the disease, the commerce that effectuates because of it and the whole industry that emerges from such a destructive medical term. A lot, in fact, are involved. Some parts are gaining, some are losing. But basically, both sides are equally involved because if one is outnumbered, the other side would just automatically subside. Just imagine a diabetes doctor not having a single client. See, one will just not exist.

In the medical profession, a number of practitioners are involved. Endocrinologists, dieticians, nurse educators, general physicians, eye doctors, podiatrists, dentists, exercise trainers, surgeons, anaesthesiologists and a lot more to research. They are just so many because of the unspecific effects the disease could bring about. The adverse complication could go from simple gum problem to eye problem to kidney problem and to a wide variety of health problems. The medical world, anyway, is ready to name names of the emerging complication. It's just so prepared that it has its own list of the names of these health damages that if you pick one of the names, you'll just go “Ahhhhh...”. Foreign. Unfamiliar.

Let me just focus on the medical branches involved in the case of my mom. The first doctor that we approached after the small peeling off of skin at her sole that turned into a sore was a general physician at our little town. He was even shaking head after taking a peek of the sore that you would not know if he was seeing something wrong or he just didn't know what's it. Perhaps, he just did not know what it was that he told us to proceed to the city to look for a specialized physician. With such an advice, we sent my mom to a city hospital where still a general physician was checking her. She was the one who first mentioned the word “diabetes” that had to be looked into. An endocrinologist was referred to who examined her and just affirmed her grave condition. Another doctor was called and now, the surgeon. There was this specific name of his specialization, i could not just recall. He was keeping a dig to the wound that he kept saying, some dead cells had to be removed. Should be removed so that these would not affect the living ones and transmission of nutrients to the affected part would continue. Days were counting and he kept on digging and digging until the wound just kept getting bigger and bigger each day. Oh, this is not good, we thought. Until finally, the doctor told us that a portion of my mom's leg could no longer be saved. It had to be cut. And he was recommending himself to perform the operation.

We could not decide right away. We had to seek for another medical advice praying that it would contrast the first opinion. We had to travel my mom to another bigger city where bigger hospitals are sprouting. A ride on a fast craft (an inter-island seacraft that would travel for 2 hours in between islands) would be necessary. Hassle but we had to.

Another surgeon took a look at my mom's medical condition, and an endocrinologist. And oh, they are a married couple both practicing in the same hospital. Funny it is that when one tells the other that he could no longer do something good to her patient the other one will start doing his job --- to cut what is there to cut. Truly, both the doctors were telling us to do their best to rejuvenate the part that was considered by the first doctor dead and could no longer be revived and had to be cut. A few practitioners also were involved in the process. The nurses, of course, a dietician, a therapist and some health care assistants to do routines of blood pressure checking and glucose count. There were medicines prescribed, a few were injectables. Could not enumerate them. But most of them were costly. Expensive.

The days turned into a routine that we found it futile to have my mom stay in hospital bed. We suggested to have her stay in an apartment to minimize the cost. We did for a couple of weeks with regular check ups to the same physicians until my mom finally decided to scream to stop the entire process. She was at a total distress. She could not anymore take everything in the same routine for another extension. She found everything not improving and instead, getting worse everyday. She could not take the small red ants crawling over her dressed wound when she kept still. She could no longer extend the bed rest. Though we tried not to tell her the escalating costs we had spent for the entire process, she figured it and could no longer take it. She decided to have her limb cut.

The surgeon was not surprised of the decision and, instead, laid to us his available schedule. And the cost. We expected it. We expected the worries we would encounter looking for financial sources. Her siblings abroad were called for assistance. Our cattles were checked if some could already be sold. Our friends had to be solicited. Our little farms maybe loaned. We had to have some to finance.

The “Leg Amputation” process (here i am again, disliking the word) was performed. An anaesthesiologist, nurses and of course, the king of the show, the surgeon were part of the performing team. During the operation, i was on a bench outside the operating room imagining what the "operators" were doing. I could even imagine a funny picture about the operation, that the surgeon on his white gown was smoking cigar and humming a lullaby while doing the cutting part. The other members of the team were also doing their second-voice humming while doing an assistance to the surgeon. In less than two (2) hours, the procedure was completed.

While on her rolling bed inside the elevator, i managed to throw a joke to my mom. I made a loud statement, "where's your other leg?". She just smiled. I could imagine the relief she was, at that moment, experiencing after the procedure. Her consoling line to herself: I am old enough to accept this fate. I am old enough to sit in a corner waiting life's finish. I am old enough to stop roaming around the world. This is just enough for me.

We went back to our town losers of the leg my mom used to have yet gaining of the relief she just felt. She was no longer suffering.

Now the recovering part.

I was a bit carried away by the scenes which flashbacked in my mind. I got lost of the topic. Remind me, this is all about the "Commerce that Evolve in the World of Diabetes". My apologies.

While recovering, my mom had to contend with the doctor's advice not to eat this, not to eat that, a few of this, a little of that, meds had to be taken and regular check-ups should be undertaken. There enters a wide array of viable commerce that could vend along the process of dealing with diabetes.

The meds are inevitable. They should not be ignored or else the glucometer reading will rise. Firstly, we had to buy a glucometer. I did. The first drugstore i went to ran out of supply. Then, we made use of one of my nurse sister's gadget, stethoscope and a sphygmomanometer for blood pressure monitoring. Then supplements. Dietary supplements for diabetics. There plays the very costly part. These supplements are just so expensive that if you buy them regularly, you really would shell out alot. They're just pocket drainers. But still, you have to, at least, fill in what's necessary. A list of drinking powders, dietary capsules and tablets are available in the market to choose from. There are just so many to choose from.

Then, food substitutes. Instead of buying raw sugar from the market for my mom's use, artificial sugar has to be bought. Instead of buying a regular ice cream, sugar-free ice cream is available. Instead of the regular coke, sugar-free coke should be produced. The list of these substitutes of regular food products are too long to choose from. And they cost higher than the regular ones. See the business?

I don't know how this whole thing came to manage itself to operate.

I could still recall the first media exposure of a diabetes product. I don't know if it was really the pioneer but it was the first that I saw. A TV celebrity endorsed it about 13 years ago when i was yet in high school. No one took the advertisement seriously as the disease was not yet too popular that time. But now, there have been alot of diabetes products created. And alot of advertisements produced.

Here comes the other business. Media. With these ads that keep on sprouting everyday, there is just a tremendous inflow of cash to the media industry. The advertisers are earning. The celebrities are likewise gaining.

Now the finale.

Diabetes creates a world of its own. Operating through a cycle that involves interaction of many. Of course, there are just two (2) groups involved in general --- the losers and the gainers. The losers are those who are directly dealing with the disease like my mom. The gainers are those who play alongside the losers. The losers cannot choose not to be one but the gainers have the great privilege to play or not to play. But mostly, play, because there is only a minute room for losing. Unfair it is but the world introduces it. We are in it. We have to accept it.





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Diabetes Mellitus



Diabetes Mellitus

Diabetes is a word not so unfamiliar to myself. Heard it way before it struck our family, cost a few sessions of depression and changed the entire setting of a happy family.

About fifteen years ago when my mother was still at her mid-forty stage, I could recall her talking about the word, how she believed she has it and how she managed to laugh at it. Diabetes at that time was not yet as popular as today that as far i've observed, doctors specializing in curing diabetes are gaining a large volume of clients and logically a considerable amount of earnings. They are gaining from the disease yet a lot of individuals are losing from it, literally, losing from it. Losing extremities. Not to mention, surgeons are at the peak of their profession cutting off limbs.

My mom could no longer laugh at the disease after her lifestyle was damaged by it. Her busy life before changed to a silent personality sitting in one of the corners of our home watching noontime television shows till nighttime. You could even talk to her whole day about how the soap operas shown from this time to that time went. She already has a reserved bundle of current events to talk about making a short talk over coffee futile. She needs an ample time to discuss everything gathered from television and radio. But that's on the lighter effect of diabetes, not to mention, the mellow-dramatic part of it.

My mom used to be a fan of leche flan, from where, i believe, my fervent non-resistant to it was obtained. She could cook it in different variations of taste. Would you believe that she used to prepare one in chocolate flavor? My apologies to preparers of said confection for revealing this creation of my mom which seems to be an unlikely menu. But really, she made it deliciously that i could not take it as a fake recipe. She even called it “Choco Flan”. And coke used to be her “liquid of relief”.

It was December of 2008 when a very little peeled-off skin from her sole led to the severing of one of her lower limbs. Most surgeons, medical professionals and medically-inclined persons call the process “Leg Amputation”. But i don't want to call it that way. It sounds too medical that it almost has a sound resemblance to amphetamine, ampicillin, ampinex, etc. However they call it,we call it, my mom was too shocked to handle her fate, her life's winning adversary.

Type 2 Diabetes Mellitus was the doctor's redundant mention. I could only understand the word “diabetes” but not anymore which type it's classified, and the word “mellitus”is just too foreign. It's a medical term, anyway, so basically, it's foreign to a not medically-exposed person, more to an accounting practitioner like myself. And our understanding of the word “diabetes”is just too basic that we often describe it as sugar-caused disease. Too much sugar that led to diabetes. Perhaps, too much leche flan. Too much choco flan. Logical, is it?

Only my nurse sister understands entirely how the disease went that way. Thanks to her. She could assist the doctor in explaining to us how the disease works, how it started and ended that way, and how it would be taken into during my mom's lifetime. They both said, our family should be watchful enough in monitoring said illness because it did not stop after the ampie (to be read as “am-pee”, for amputation. Really, i just don't like the word) process. It did not stop after the pain of losing one leg. It has now drastically invaded my mom's life.

From media to table conversations, diabetes has indeed managed to gain popularity. Popularity that brings about lucrative professional undertakings and creates its own damaging personality. Dietary supplements in forms of coffee, milk, capsules, etc. have been created to address the illness. Well-known confections and sweet food products have considered adding in “diabetes-shield”ingredients just so not to be feared by lovers of the food. Coca-cola has its own “No Sugar Coke” while Pepsi also has the same. Sugar-free cakes have been invented. I even have this supply of sugar-free menthol candies. The world has feared diabetes and has taken it seriously.

My family was looking for layman's explanation of the disease specifically on how the small peeling off of skin led to the ampie of my mom's leg. The doctor's explanation was quite vague at first so i tried figuring out though my analytical interpretation on how it could possibly work. He started by mentioning insulin, the defect of bodily tissues, the excessive intake of sugar and the non-absorption of sugar by bodily cells making its volume to stay in the blood, clog the bloodstream and affect the distribution of nutrients to the entire system. I don't know if my interpretation of his explanation is correct but that's how i took it and lived it.

As i could understand it, a hormone in the body called insulin produced by the pancreas is no longer effective in absorbing glucose (sugar) to be used as energy in the body. Accordingly, muscle cells and fat cells require insulin in absorbing glucose for energy purposes. With such defect that sugar taken into the body from foods eaten may no longer be used, organs in the body which basically are made up of muscles and fats which function as distributors of nutrients in the entire bodily system may no longer be in good condition to function. Adverse medical effects, hence, could occur. In my mom's case, nutrients that could have been distributed to one of her legs did not reach to the lowest part of her body (the “sole” part) causing it to decay. The little peeling off of skin was just a show of the decay occurring in said leg. In reality, tissues forming up my mom's leg were already dead and in gangrene stage and so, had to be severed.

Doctor's advice was to monitor my mom's sugar level – reduce sugar intake, do a little exercise to well-manage blood circulation and take sugar-reducing meds. As of now, mom is well handling it. But sometimes, her sugar could reach so high that we have to send her to a doctor (80 kilometers away). She just don't love it – riding on a hired car and suffer on making request to the driver to pee. Just so unlikely. But she had to be seen by a doctor. Sometimes, she would be injected with insulin.

We know, it would not stop from here. And we know, there are a lot of things to happen. Praying that everything will just turn so okay with our layman's understanding against the medical way.






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