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Dialysis Discussion => Dialysis: News Articles => Topic started by: okarol on April 03, 2011, 12:33:02 PM
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Diabetes and demons: Every day is a challenge for local double amputee
By ANIKA CLARK
aclark@s-t.com
April 03, 2011 12:00 AM
FALL RIVER — It's shortly after 10 a.m. at a dialysis center, and Carlos Raposa — sitting in a red motorized chair with a Save-A-Lot bag draped from the back — is falling asleep.
The 49-year-old diabetic waits for a blood-filtering procedure he despises, but must do for three hours, three days a week for the rest of his life.
Gone is the humor he showed one afternoon while motoring down South Main Street, or the mischievous grin he flashes when kidding around.
His face is drawn, his eyes seem dull and resigned. He scratches at itches hidden by his gray sweats, and he waits.
"Every day going there, it's 'Son of a (expletive), "» I hate it," Raposa grumbled in a prior interview. "All you do is sit down on the chair with the big needles in your (arm)."
Raposa's recent years of dialysis — in which a machine performs the basic blood-filtering his kidneys can no longer manage — represents enough health woes for a lifetime.
But for Raposa, it's just the latest in a debilitating journey that started long before he became a double amputee.
Hanging on the wall of his Fall River apartment is a picture of Raposa from his days in the Army National Guard. The handsome young soldier stares forward with dark, Portuguese eyes, holding a gun.
"I became No. 1 ... shooting the mortar," Raposa said, looking like he could be a war casualty with legs that narrow to two prosthetics. "I've got a couple of plaques over there."
Raposa never went to battle, but he's spent decades fighting sickness, addiction and depression.
His story began nearly 50 years ago on the Azores island of Sao Miguel, where Raposa was born before immigrating to the United States at six years old.
The oldest of eight children, Raposa "was a strong kid, "» always joking around," recalled his father, Jose Raposa, from a bar stool at the Academica on South Main Street.
At 18, Raposa became an American citizen, enlisted in the National Guard and headed out to Fort Benning, Ga. He married the girl he'd been dating since he was a 15, had a daughter, and somewhere along the way — more than 30 years ago — was diagnosed with Type-1 diabetes.
The disease is prevalent in SouthCoast and beyond, but Type-1 diabetes affects only about 5 percent of the diabetic population, according to the American Diabetes Association.
People who suffer from Type-2 diabetes don't make enough insulin or their cells ignore the crucial hormone, according to the ADA, but people with Type-1 diabetes don't make insulin at all.
Made by the pancreas, insulin is a hormone that enables glucose (a sugar) to leave the bloodstream and enter cells.
People who suffer from diabetes either don't produce insulin at all, don't produce enough of it or have cells that ignore the hormone.
The result? Glucose concentrates in the blood and the cells don't get the energy they need.
While not differentiating between Type-1 or Type-2 diabetes, Massachusetts Department of Public Health's community health information profiles, which draw from different years, show how hard the disease has hit SouthCoast.
New Bedford and Fall River exceeded the state's 7.5 percent prevalence of diabetes, with identical statistics of 10 percent, while men and women from both communities also showed higher percentages for every listed diabetes complication and risk factor, including high blood pressure, high cholesterol, stroke, angina or coronary heart disease and obesity.
The diabetes-related inpatient hospitalization rates were also higher in New Bedford and Fall River, as were diabetes-related emergency room visits, observational hospital stays and death.
It's the sight of Raposa bumming a cigarette from his friend, Richard Sterne, that drives these figures home.
Like Raposa, Sterne suffers from diabetes and is a double below-the-knee amputee.
"So I used to be 6'2, now I'm 4'8, I don't care," Sterne later quipped to The Standard-Times. "When I can use my adversity to put a smile on someone's face or make them laugh, I consider that a productive day."
"Depressed, miserable"
Raposa's medical problems don't end with his diabetes.
In addition to suffering skin-splitting psoriasis so bad he'd drive a forklift with Vaseline-slathered hands, "I was young, I was depressed, miserable," said Raposa, whose marriage crumbled long ago. "I was doing a lot of drugs."
He went straight to heroin — "I tried it. I liked it," he said — before getting on methadone.
He also earned a criminal record with charges that included drug possession, larceny and drug distribution, and various jail sentences from 1993 to 2000.
Asked his earliest memories of his big brother, Richie Raposa, 34, pauses.
"They're bad memories. No, a lot of them are good, but most of them, you know — he was going through a tough time," said Richie, the youngest of eight. "And I was a teen and I was dealing with my own personal issues, too. ... But he was always there for me if I needed him."
Now working as his brother's personal care attendant, Richie said the two have a new mutual respect and understanding.
"Going through a divorce and losing a family, it's a lot," Richie said. "I didn't understand it then, but I do now."
But life had even more in store for Raposa, thanks to an injury that would likely prove minor to a non-diabetic.
Barefoot in Fairhaven several years ago, Raposa — once an avid recreational fisherman — stepped on a seashell. The shell pierced his skin, drew blood. "Then, a couple of weeks later, I just noticed it getting black," he said.
An infection that started in a single toe began to climb his right leg.
Jennifer DeRossi-daCosta — a certified diabetes educator for Southcoast Diabetes Management Program, who does not work with Raposa — described infection as a constant concern for people with diabetes.
"We tell all our patients to pay special attention to their feet, ... especially if they have any kind of nerve damage or circulation issues," said DeRossi-daCosta, who is a Type-1 diabetic herself and checks her feet daily for cuts, cracks, blisters or any changes — even a thickening toenail — that could point to fungus or poor blood flow.
Diabetes-related circulation problems can make it difficult for infections to heal, she explained, and "if their blood sugars are running high... it's the perfect spot for an infection to want to live in."
By constricting blood vessels, she added, smoking makes the situation even worse.
Ultimately Raposa's leg was amputated below the knee. But soon after, the cycle of infection started in the only leg he had left.
Within months of his first amputation. Raposa was a double-amputee.
"I was in bed for a long time. Just sitting in bed. And I'm a hyper person," Raposa said. "I hate sitting in one spot."
"I'm already bored"
Bitter boredom is now his reality — as was clear one recent afternoon when he sat on his bed and explained why, on that particular day, he seemed so sad.
"I know it's getting dark out already and I'm already bored," Raposa explained, his voice wavering, his eyes moist. "I used to walk the streets all the time. I used to be with my friends. I used to run... ."
Richie Raposa envisions a time when his brother can use a walker to get to and from his kitchen.
"I ... try to get him to do some physical therapy around the house here ... but he's having a hard time with these legs. They're too heavy for him to balance himself," said Richie, who also works as a certified nursing assistant at Somerset Ridge Center.
Carlos Raposa said he's trying to get new legs. In the meantime, while he used to be able to hoist himself up his parents' stairs, his body's weak.
Once a fitness buff, Raposa can no longer lift a gallon of milk.
"He can't even twist open a cap of his iced tea," Richie Raposa said. "We have to pre-twist open his drinks. ... Diabetics are known to have neuropathy of the fingertips and stuff, so I think that's really what's going on."
Meanwhile, he must contend with the kidney disease that's a constant throughout.
"Basically, he developed renal failure through the diabetes," Richie Raposa explained. "Keeping up with the dialysis is what's keeping him alive."
If Raposa follows his dialysis regimen the next five years, he will spend the equivalent of nearly 100 days and nights hooked to a machine.
But he hasn't always been compliant.
At one point, "I was skipping days." Raposa said. "So I ended up full of fluid in my lungs, in my heart. ... I couldn't breathe, so I was in the hospital for six days."
Even so, at a recent dialysis appointment, a staff member reminded him he's supposed to stay on the machine for three hours.
"I do three hours. I do two and a half," Raposa told The Standard-Times. "I do what I can."
DAILY STRUGGLE
The same might be said for how Raposa now lives his life.
He motors the half-mile between his apartment and the Academica, past a sweets shop, past a window display of the Azores and past the slew of people who greet him on his way.
"What he may have done to himself, you know, is damage he's done to himself," said Richie Raposa, who described his own generalized anxiety and said struggles with worry and sleeplessness seem to run in the family. "He would never hurt another person. ... He just doesn't have it in him."
While Carlos Raposa said he's clean after his many years of drug use, he still smokes and drinks, even though the latter worries his father, and Raposa said it compromises his chances for a kidney transplant.
Contrary to his dad's fears, Raposa said he doesn't drink too much — just a nip here and there — and said he could kick the behavior if he wanted to.
"It's just I'm bored at home," he said. So "I like to have a drink."
When he can overcome the insomnia, he sleeps facing a wall of photos of his grown daughter. He cries a lot.
But, Richie Raposa said, Carlos "still manages to make people laugh and crack a smile every now and then."
During a conversation in Raposa's living room, it's the recollection of past romance that brings that grin to his face.
"I was a stud," he said. "I had a lot of girlfriends."
He savors the memory. And he flashes a rare smile that shows he means it.
http://news.bostonherald.com/news/regional/view/20110403diabetes_and_demons_every_day_is_a_challenge_for_local_double_amputee/