“You’re going to lose that toe,” the PA said, frowning as she inspected my toe.

“Maybe not?” I sighed and blinked away a tear. 

“We’ll see what Doc says when he comes in, but we’re ordering an MRI, and he’ll do surgery early next week.”

Dammit. 

Another fucking toe. 

Down to eight. 

I guess eight is my new lucky number.

She put her hand on my arm. “Hey, we’re going to take good care of you. We don’t want an infection going into the bones. You can get around just fine without the toe, but we don’t want you to lose a foot.” 

She stood to leave. “Doc will be right in. He’s looking at your x-rays now.” 

With that, she left me alone in the exam room. 

How the hell do I have time for this right now? Daddy is still not out of the woods. Someone’s got to stay with him all day and night. 

Fuck-fuck-fuck.

I have no money. I haven’t worked since November. 

There’s no cushion left. 

What the hell am I going to do? 

“Hey, hey!” Dr. Holt popped into my room wearing a tracksuit, looking like he just returned from a brisk run. 

“I looked at your x-rays and yeah, I just ordered an MRI. We’re getting you in this afternoon. Let me have a look at your toe.” 

He squatted down onto a rolling stool. “May I?” I nodded, and he gently pulled my calf up to his knees to examine my sick little toe. 

He looked up at me after prodding my toe, his gray eyes filled with concern.

“What happened, Donna?” 

My eyes met his, and I sighed. “I don’t really know what happened, Doc. My dad got sick in November, pulmonary problems led to congestive heart failure. Plus, he fell and banged his head a couple of weeks ago so we’re dealing with a brain bleed, too. He needs 24/7 care right now, so I’ve been staying with him.” 

Dr. Holt studied me intently while I described my recent weeks. He then focused on all my toes and my swollen right ankle. “When did you notice there was something going on with this toe?”

“I noticed it back in December. I tried keeping it dry, cushioned it a little so it wouldn’t rub in my shoe. It’s been about three weeks since I noticed something was wrong with it. I tried calling you a couple of weeks ago, but you were out for the holidays. It didn’t really start hurting until a week or so ago.” 

Was I making excuses for this fucking toe? 

“How have your blood sugars been?”

“They’re at around 100, consistently.”

“That’s great news! Let’s keep them that way.” He kept feeling around my ankles. 

“Look, I’m very sorry that you’re going to lose your toe, but I’m also concerned about the diminished pulses in your feet.”

“Diminished pulses?” 

“Do you notice any pain in your feet after light activity? Do your feet curl while you’re sleeping and then cramp? Do you wake up with Charley horses at night?”

Yeah, at least twice a week, I wake up screaming because of the painful cramps in my legs. Sometimes both legs at the same time. Sometimes multiple times at night. 

I nodded as I described the cramps I’d had in my legs for the last year or so. 

He put my right foot back on the floor and then placed his hand on my knee. “Donna, I can’t feel any pulse in your left ankle or toes and the pulse is very faint in your right ankle and foot.” 

“I think you might have peripheral artery disease. Do you know what that is?”

Yeah, I knew what it was. My mother had it, along with a zillion other health problems. 

“Mom had it, along with carotid stenosis. She had both carotids cleaned out, but she ended up with a stroke, anyway. I don’t know about her legs, but she was in a wheelchair with a spinal cord injury, so she never really complained about leg pain. She had occasional cramps in her legs, though.”

“Was she diabetic?”

“Yes, and never very well-controlled. She had ulcers on her feet that took forever to heal. I had to go over every night and dress them for her.”

He studied me while I gave him detail about Mom’s legs and feet, about how she didn’t have to shave her legs anymore because her hair quit growing and how she never noticed how ice-cold her feet were when I changed her dressings. 

“Donna, based on what you’re telling me about your mother, it sounds like she had PAD. I think the ulcers on her feet weren’t so much from diabetes as from poor circulation in her lower limbs.”

He told me he wanted me to have an ultrasound and arterial brachial index of both my legs, as soon as possible, before he amputated my toe. 

He was happy to hear that I worked for an interventional radiologist group. “Good! Maybe they can get you in today or tomorrow. What’s your doctor’s name? I’ll call him and give him the detail on your toe.”

Whoa. Wait up there, big guy. 

“Doc, I work there. I’m not a patient there.”

He smiled. “You are now, Donna. We gotta get you taken care of, stat. I want to know what your arteries look like on the inside before we do surgery.”

Peripheral Artery Disease, or PAD, affects over 6.5 million Americans. Classic symptoms include leg pain with physical activity and numbness or weakness in your legs. 

Almost 40% of people with PAD show no symptoms. 

The American Diabetes Association says 1 in 3 people with diabetes over the age of 50 have PAD. 

Even though my mother had it, I knew next to nothing about PAD when my doctor diagnosed me. 

I’m a little resentful that my primary care physician, an internist, provided no information to me on PAD for the ten years she treated my diabetes. Maybe that’s harsh; I’m sure she focused on more pressing issues during that time, but if I’d had an ultrasound and ABI eight or ten years ago, it may have saved the two toes I’ve lost. It makes me wonder if PAD in younger patients isn’t something that’s on the medical radar for PCP’s.

I’ll provide more info on PAD in future posts. In the meantime, if you or a loved one is a diabetic, read the links I shared above to find out what you can do to prevent PAD, reduce symptoms, and avoid amputation. 

Thanks for reading. Please comment to let me know your thoughts on this subject.