In the past 3.5 months I have been generally healthy. It has been a little more work to figure out food and carbohydrate counts of meals, but this is a daily diabetic task wherever you are. However, what I wasn't expecting was getting colds once a month. Right after we first arrived in Europe I got a cold. Then right after we arrived in South Africa I got a cold and finally another one almost a month later.
I chalk this up to 'new enviroment = new germs' and a generally weakened immune system. However, of all the illnesses to get I am thankful it was just colds.
Besides taking malaria pills there was only my toe problem that had to be dealt with. There was nothing else that had to be treated or prevented. In the spirit of transparency about diabetic problems, despite my strong aversion to talking about my feet, I will explain the problem for all who care to continue reading.
For several years on and off I have had problems with infections along the side of the nail of one of my toes. This problem has nothing to do with diabetes but the necessity of getting it healed quickly has everything to do with diabetes. One of the complications of diabetes is nerve disease (neuropathy) which results in limited feeling or no feeling especially in the feet and hands. I have the very beginning signs of neuropathy in my feet. Neuropathy can cause diabetics to not realize when they have cuts, infections, blisters, etc on their feet and thus can subsequently result in a lack of treatment which in the case of infections can result in gangrene and amputation.
Knowing that we were going on this trip and knowing that we would be walking everywhere made the reoccuring infection really irritating. The problem arose again in June 2008 and I went to a podatrist who treated the infection. Two and a half months later the infection was back and I was particularly worried. The podatrist suggested that I have part of the nail removed from that toe and a chemical put on the skin so that the nail would not grow back, hopefully solving the problem. I had this procedure done in September only two weeks before we took off. For the first few days I seemed to be healing fine but then I got a horrible infection, much worse than I had ever experienced before. A full course of antibiotics helped the infection to go away but the toe remained puffy and irritated. For the next month and a half on the road I soaked my foot in hot salt water almost every day to keep infection away and try to get the toe to heal, but it would not heal.
It wasn't until we were in Nelspruit, South Africa that we had the time and relationship with people to understand how the health care system worked and get the recommendation of a good podatrist. In the private sector of health (South Africa also has state run health care) you are able to completely choose your doctors but you are also fully responsible for the bill. And while private care is certainly much more expensive than state care, compared to US prices even when insurance is paying, it is ridiculously cheap. I paid a total of $30 USD for the entire appointment. Another bonus of the South African private health care market is that doctors have more time to see you. In the US I am generally given just 15 minutes with my doctor which is never enough (for me or any other patient) and which usually results in doctors running late for all their appointments.
Dr. Fuhrie (in Nelspruit, South Africa) saw me for an hour and explained many things that my podatrist in the US should have explained to me before the procedure, namely that the chemical he put on my skin to ensure that the nail would not grow back is harsh acid and often times wounds the skin. Thus the reason for my horrible infection. The acid also made the good (not removed) part of the nail splinter which resulted in a piece of the nail sticking into the toe making it red and puffy. Dr. Fuhrie removed this piece and the toe healed in a week.
When we were back in the States briefly in January I had my regular, every three months, appointment with my endocrinologist and I had my regular labs done. I expect my A1C (three month blood sugar summary) to be higher than normal, not because of travel, but because of getting three colds. When diabetics are sick it is much more difficult to control blood sugar. Because of this back-to-back cold record I fully expected to get another cold when we arrived in Bangkok (again, simply because of being exposed to new germs) but I'm happy to report that I haven't seemed to pick anything new up yet.
Thus, my conclusion from the 3.5 months of travel is that while there is a certain inherent risk when traveling internationally as a diabetic I believe that with a lot of forethought and work before the trip any diabetic travel. Also as a result of this trip there is a certain courage that has replaced some of the fear that I used to carry as a diabetic, and that far outweights the struggle of getting supplies and three colds.
I hope this will encourage other diabetics to not feel limited in their travel dreams.
Andrea
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