long walk tomorrow

It won't be a super-long walk, but tomorrow, I'm going to try walking down to Bundang—an 18K walk that I haven't done in a million years. I've done some walks, over the past few weeks, that have lasted around 90 minutes, but since my strategy, up to now, has been to try to stay off my toe wound (diabetic ulcer), I haven't been very disciplined about this. Now, though, I've decided Fuck the wound, and I'm going to make walking a regular thing again, starting tomorrow. I've also been tentatively doing some staircase work up to now, but I'm going to ramp that up as well. Doing the stairs will lead to cardiovascular improvement far faster than regular walking will because of the intensity.

Why the change in strategy? I've been telling myself that I won't visit the toe doc until I get my numbers (weight, BP, glucose) back down to something reasonable. I spent a lot of last year undisciplined, just regaining most of the weight I'd lost, so it feels almost as if I'm having to start again at Square One. For the past few weeks, I've been quietly dieting, and while I'm not weighing myself yet, I've been tracking my size via belt holes: how tightly can I cinch my belt? Each of my belts is a bit different, so with each belt, I have to set a baseline standard and work from there. With the belt I'm currently using, my baseline was the belt's 6th hole. Over the past few weeks, I've seen my waist thin out to the point where I can now tighten things down to the 8th hole (a change visible only to me as I've got another 10-12 inches of waistline to lose). This particular belt has only nine holes, so I'm going to have to switch belts soon. My previous old leather belt had to be thrown out after it got too old—it was shedding flecks of leather dandruff and starting to get fragile. I have another leather belt of almost exactly the same type; it's currently doing duty as my Gregory backpack's hip belt, but I think I can switch belts without there being a problem. So when I reach the 9th hole of my current belt, I'll switch it out with the leather hip belt, and if necessary, I can punch as many extra holes as I want into the hip belt because I have a belt-hole puncher.

Switching belts will mean adopting a new baseline, but them's the breaks when it comes to different belts. In the meantime, my thinking is that, even though my toe-care regime is all wrong, it's been preventing infection for months. By walking regularly again on top of dieting, I'll be able to accelerate weight loss and arrive at the point where I won't feel ashamed about seeing the toe doc (who will likely want to do a blood test to confirm I've got a diabetic ulcer). Walking means bleeding, but up to now, I don't seem to bleed that much on my 90-minute walks. I doubt my toe will start geysering if I do an 18K mini-trek.

So we're very much in risk/reward territory. Walking risks worsening the wound, but it provides other health benefits. The perimeter of the wound, meanwhile, has a lot of callus built up around it. I've stopped snipping that callus off: by letting the callus develop, I let my body naturally reinforce the wound. My care regime involves wiping my toe with an all-purpose disposable wipe first, then swabbing the wound area more closely with an alcohol swab, then attacking the interior of the wound with a Q-tip dipped in hydrogen peroxide. All of this would be extremely painful were it not for diabetic numbness: I feel nothing when I'm digging into my wound with a Q-tip. In watching some ulcer-related videos on YouTube, I discovered that alcohol and peroxide are exactly the wrong things to be using, for reasons that I already suspected: while alcohol and peroxide do indeed kill all the pathogens in the wound, they also kill all the "good" cells that are trying to heal the wound. So the wound never gets infected, but it also never heals. Result: I change my bandages every few hours, and in my apartment, when I'm not wearing shoes, I've trained myself to lift my toe off the ground to keep myself from leaving blood spots all over the floor. As long as there's no pressure on my toe, bleeding is extremely light, little more than a mere seepage. But when I walk normally with my shoes on (as when I go to work), the pressure squeezes blood out of the wound, soaking through the bandage and into my sock. At home, with no socks on my feet, I leave blood spots on the floor if I forget to pull my toe up and back. This toe-retraction is probably fucking up muscles and tendons in the ankle area of my leg, but what can I do?

The videos I've watched talk about what I can do. First, visit a podiatrist. Next, get the wound treated with a special hormone-infused cream that fights infection while also aiding the healing process. Finally, get diabetic-ulcer footwear that takes pressure off the toe. This usually means a special shoe with part of the sole cut away so the toe can hang freely without ever pressing against the ground. Most of the docs on YouTube say that a person with a diabetic foot ulcer shouldn't be barefoot at home, which goes against the grain of my Koreanized reflexes: in Korea, you always take your shoes off inside the home. Many restaurants require this, too.

Infection-fighting is crucial if I don't want to lose my toe. All the YouTube docs say that, once infection reaches the bone, the digit is done for. I'm going to have to be doubly vigilant about my toe after long walks: the foot, once inside my shoe, is in a dark, sweaty environment that bacteria love. I'm going to have to bring along material so that I can change out my bandages in the middle of or after a walk. As the weeks go on, I'm also going to have to be mindful of my supplies of bandages, alcohol swabs, Q-tips, Kleenex (for dabbing my toe dry after treatment), and hydrogen peroxide, which is a bitch to say in Korean: 과산화수소 (gwa-san-hwa-su-so, hyphenated to make the syllables easier to see) according to Google Translate.

My 90-minute walks have been tiring. I'm totally out of shape after having done effectively zero walking since last October (there was one 20K walk last November, but that was it). So I'm not expecting tomorrow's walk to be easy, but with spring on the way, it's time to ramp up the exercise intensity, both on the bike path and on the staircases. Wish me luck.

Don't look at the following gallery if you're easily grossed out, but here's a series of pics taken in late January (still valid because nothing has changed), showing what my toe-cleaning procedure looks like in all of its dirty, gritty glory.

The pic above shows what my sock looks like after a typical day at work. Ideally, I change my bandages every 4 or 5 hours, but I have many days when I go the entire work day without treating myself, changing my dressing only after I get back home. Note how black and smooth the blood is. At first, I thought the sock was picking up all the previous blood from previous bleeds, but no: that's the day's blood. I know this because, when I checked the inside of my shoe at one point, I saw there was little to no blood collected in the shoe itself. That surprised me. I'm guessing the blood rapidly blackened thanks to the constant pressure on the toe from a normal work day's in-office walking. Upshot: every night, I have to launder my bloody sock. It's gotten to the point, though, where my socks all have toe stains—discolorations of the fabric that can't be removed without bleach.

In the pic below, look at how the bandage doesn't appear very bloody at all. It's as if the blood bypasses the bandage and collects in the sock. Capillary action?

Even when I peel off the bandage, there's not much collected blood:

A close look at the toe wound:

You can fit a pencil eraser in there.

An even closer look. The gray stuff is just bloodless tissue, not an infection:

The first round of cleaning involves a regular disposable wipe:

Wiping down the toe:

The second round of cleaning, with an alcohol wipe, focuses on the wound:

I clean the wound's perimeter (lots of callus):

The final round of cleaning is inside the wound using hydrogen peroxide:

You're never sold pure H2O2. It's always 2.5-3.5% solution.

Into the toe we go:

Thanks to diabetic numbness, there's no pain:

Peroxide fizzes when in contact with blood:

Hard to see here, but the Q-tip is now a bit discolored:

After a dry-off with Kleenex, it's time to bandage the wound:

And now, I'm good for the next few hours:

I get that I might deserve this ulcer because I misbehaved so often last year, but the thing that chaps my ass is that the ulcer began forming while I was circumnavigating Jeju, i.e., during a time when my blood sugar is especially low. No justice in the world, right? Tanj.