Ed Bryant’s hand traced the beige wall of his Columbia home as he moved down the stairs, his fingertips having become a steady means of navigation since he lost his eyes to diabetes 20 years ago.
Bryant’s most apparent features stand out: slumped shoulders and lean body, just like the solemn farmer in the painting “American Gothic.” It takes a second glance to notice the polished pupil in Bryant’s left eye never moves from its slight slant to the left, or that his right eye perpetually gazes straight ahead.
Bryant purchased the painted molds — called Scleral Shells — now positioned in his sockets after doctors removed his original eyes and he learned that the eyeballs had been what held his eyelids up.
Bryant, 61, is a Type 1 diabetic, but retinopathy invaded his eyes as slowly as it does among Type 2 diabetics.
“I didn’t have too much emotion about losing my eyes,” he said. “It hurt pretty badly, and I just wanted to get rid of (the pain).”
The most common cause of blindness among Americans, retinopathy occurs among diabetics when high blood pressure weakens tiny blood vessels in the eye. The vessels develop small bulges that eventually burst and bleed into the eye, at first clouding the vision, then forming scar tissue, separating the layers of the retina and destroying a person’s vision.
In cases such as Bryant’s, leaking blood vessels shrink the eyeballs to a size where they no longer hold the eyelids open and require removal.
Bryant said he relies on friends and strangers to help him through each day. What he misses most, he said, is the freedom to hop into his car and zip off on a whim. Now he rides in taxis, knowing which drivers treat him honestly when he hands them dollar bills, carefully folded according to value.
He shops for clothing where the salesmen know him and his tastes. Blue jeans are always his first choice, since he said they match any color shirt.
At home, technology replaces his sight. His watch chirps the hour in a firm, female voice. “It is now 2 o’clock,” she says on a recent afternoon.
Drawing insulin shots took practice, but a “count-a-dose” machine helps, emitting a clicking sound for every milliliter of insulin he draws from the vial into the syringe.
Being blind may make things harder, he said, but it isn’t the end of life altogether.
“I don’t know if I always had a great attitude,” he said. “But I pretty much knew the blindness was coming. It would’ve been different if I’d been in a car accident and boom — lost my sight all at once. But I could tell it was getting worse.”
Bryant’s doctors gave him vague suggestions on how to manage his diabetes when they diagnosed him when he was 14, he said, but as he entered his late teens, the adventures before the traveling photographer distracted him from his diabetic responsibilities.
“‘Not taking so good care of myself’ is a nice way to put it,” he said, remembering the constant cross-country road trips that landed him behind far more restaurant menus than stovetops. He often ordered large-portion entrees and desserts, not knowing his sweet tooth caused his blood sugar to soar.
“After all those years, it just added up too much,” he said. “I just didn’t realize what it could do to you, which is what I think happens to most people, because you don’t feel any different than you ever felt. Then it catches up to you.”
His eating habits caught up to him shortly after he turned 30. Although his traveling across the country earned him a promotion to a desk job as national supervisor of the photography company for which he worked, he found his victory inconvenienced when his paperwork grew more and more blurry.
“I went to see a specialist and he said, ‘You’re blind in one eye,’” Bryant said. “I didn’t even know it, because my other eye compensated.”
When he almost ran over someone as he was driving home from work because he couldn’t see the road, he knew it was the beginning of the end for his other eye.
Bryant started managing his diet in hopes of maintaining his sight as long as possible.
He might still be able to see, he said, if not for a girl he had been dating at the time.
“We were just horsing around one night on her couch,” he remembered with a half-smile beneath his gray mustache, “then she accidentally jabbed her finger into my good eye. It was a bloody mess.”
The jab finished off the blood vessels already ruptured from the retinopathy.
He had surgery to scoop the scar tissue out of his eyes. It wasn’t long after he returned home, though, that the glare of the television a few feet away became harder and harder to see.
Finally, there was nothing.
“Diabetes is a mean disease; it’s insidious,” he said.
Shortly after doctors removed his eyes, they took one of his kidneys, as well. Also caused by high blood sugar, kidney disease occurs among 30 percent of diabetics. There are only two treatments: dialysis or transplant.
Bryant spent three years on dialysis, which involved hooking tubes to his arm from a machine that was the size of a small refrigerator. The tubes pumped blood out of his body into the machine, which filtered out waste and excess water before sending it back into his body. The process typically took about three hours, three days a week, and required abstinence from meat and most salts, as well as limited intake of liquids. Bryant curtly described the three years as “not any fun.”
In 1983, he got a kidney transplant. He knows his transplanted kidney could just reject his body one day.
Now, Bryant manages his diabetes like clockwork. Meals are five hours apart, preceded by an insulin shot. He exercises three times a week on a treadmill parked in his garage. He enjoys sugar and fat in moderation when he eats out, knowing his eyes and kidney are small losses compared to the cardiovascular disease that kills more diabetics than any other complication of the disease.
“Keeping your diet under control is the key thing, so that’s what I’ve done for quite a while now,” he said. “I still have these problems, which took years to develop, but once you have ’em, you have ’em. Life goes on.”
As an editor for Voice, a publication written for and about diabetics, he also shares his experiences with other diabetics. Four phonebook-sized recorders sit on his desk, and he uses them to listen to recordings of articles before taping his comments. Despite the personal experiences he shares with diabetics, though, he finds many are on track to where he ended up, showing no sign of changing direction.
“Why they don’t take better care of themselves, I don’t know,” he said, shaking his head. “People can live a normal lifespan if they take care of their diabetes, but that’s the key thing — getting them to take care of themselves. Some adults just don’t have a problem with it, (their bad habits are) so ingrained.”
St. Mary’s Health Center in Jefferson City, which has a center for treating wounds lasting longer than one month, sees a steady stream of different wake-up calls for diabetics, who learn the hard way that end stages can cause a whole new wave of emergencies. In the case of neuropathy, or loss of sensation in the foot, negligence can lead to foot wounds with a multicolored spectrum of bacterial infections. These cases represent 10 percent of wounds the hospital center treats.
Neuropathy occurs when high blood sugar damages blood vessels. Like an electrical cord with a damaged outer coating, the nerve fibers fail to function properly and stop sending signals back and forth. If diabetics don’t normalize their blood sugar when they notice the soles and heels of their feet going numb, they eventually lose feeling entirely.
Neuropathy, the most common end stage of diabetes, is incurable because nerves can’t regenerate. This leaves feet vulnerable to gangrene, hardened arteries and lessened blood circulation. Low blood circulation impedes healing in the foot, and the body can’t repair something as small as a simple blister or cut. Since a diabetic with neuropathy can’t feel any pain to signal a problem, a foot blister can tear into a wound. With neuropathy, skin and muscle tissue can degrade under the pressure of tight shoes and walking.
Diabetes also affects the body’s ability to regulate body temperature, which can cause feet to dry and crack, increasing exposure to bacteria. Like all aspects of diabetes, problems in an untreated wound add up and can produce a cornucopia of festering bacteria, blood and nonviable tissue known as “slough.”
Matt Fiori, a nurse practitioner in wound care at St. Mary’s Health Center, treats a variety of diabetic foot wounds. They range from black, shriveled, gangrene-infected toes to inflamed gashes eaten straight down to the bone, with blisters hardening around the wound after being walked upon for weeks. Sometimes patients have bottle caps and tacks in their heels.
That, Fiori said, is why diabetics with neuropathy have an essential daily task.
“We can’t emphasize enough how important it is to check the feet every day, to wear proper footwear,” Fiori said. “But you’d be surprised at some of the folks who choose not to.”
He said he asks patients why when he slices off a shred of skin to send to the hospital lab for a list of possible antibiotic treatments.
“The typical answer is, ‘I don’t have enough time,’” he said. “My perception is they don’t completely understand, or they may not care.”
Diabetics with neuropathy enjoy one small convenience, Fiori said. When the nurses clean the wound, no anesthetic is necessary.
“People don’t feel it because they’re completely insensitive (in the foot),” he said.
Often, up to three bacterial organisms may infect a wound, which requires treatment beyond a Band-Aid.
Patients with normal blood sugar heal faster because blood carries oxygen to the wound more easily. For many diabetics, however, blood circulation needs outside help, which can mean climbing into something called a hyperbaric chamber.
The glass, coffin-like compartment is pressurized with 100 percent oxygen, which patients breathe in. Blood plasma becomes saturated with oxygen to heal the wound.
The process takes 90 minutes, and patients leave the center with cushioned boots and antibiotics. The healing can last weeks or months. Patients who leave behind their crutches or special footwear for a day, however, may redamage their foot and have to start the entire process all over again.