Continuing the Conversation; Deep dive

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1:18 Well, good evening, good evening, good evening, and welcome to another fabulous show, fabulous opportunity to enhance your knowledge, to get to hear something you normally don't hear, and to participate. Welcome to another segment with setting it Straight with Miss Gray, Thank you so much and her fabulous co hosts. Of course, we are continuing with acknowledging and identifying and being aware of national limb loss and limb difference. We have a guest tonight, but before I go into further, let's take it to. The throne room in prayer. Lord, we just thank you today, we praise you, we give you glory you alone are worthy to be praised. We just thank you for this opportunity. Now, this is your boys. These we're your fool, your children, we're your peace.

2:00 We're gonna get. Behind the cross and let you do what you do best, and that's set your captives free. In Jesus name, we pray, Amen and amen. Well, thank you, Trey. How's the weather up there? I know you enjoying yourself. I know, yes, yes, for the coon of this week. It was eighties nineties last week, and I think we're fifties this week. Wow. Okay, Okay, Well it's okay, it's okay because May is right around the corner now. Now if we're going into the sixties in May, we okay, we got a problem. The ice is melting somewhere and we're in troubles. Amen and amen, I okay, roll call. Where's the audience?

2:40 All right, audience, we need y'all checking in tonight. Okay, be safe while you do it, but we need everybody checking in in the name of Jesus, So roll call this show because we've got a guest tonight, and a fabulous guest at that. So what I want to see who's on the horn who's listening in. Before we bring. Her in, I want to give a show out out to our funders, our donors who I know I mentioned a few last week. I was waiting on a few more donations came in. But my ABC Prosthetic company here in Orlando, doctor my foot surgeon, doctor Latrelle Healing Soul Peddietary, and that's the guest UH member that's going to be on tonight. Who else? Mims Carolyn the Northern area of Florida here, a colleague of mine and good friend, one of my spiritual daughters donated. My twins donated, So I'm giving y'all a shout out. Thank you so much, ms Kay and to your twin mister k I'm just I was surprised if those and even one of the guests that showed up that attended also gave a financial donation which she didn't have to. And of course Tennessee came through.

3:50 I'm not leaving them out. I got their their their donation. It was very sweet, very well needed, So I thank you, And of course I've sent out a fabulous shot out to IHAP Restaurant here in on the Orlando area, to mister Ron who is the manager over there. He's just he's just great and his words are your family, you know. So anything you need me to do, you know, we will step up and we do it. So they did, and and the our newest partners. It's a salvation army and the Men's Shelter in particular. I hope I did not leave anybody out. I don't think. Oh Desire for All Nations pass Oldia here also gave a donation, so we're just thankful for that, and uh, you know, thank you all. I just just say hey, you know, hey, Micky, how you doing. Okay, we're here, We're here. Okay, that's the crew there, got you.

4:42 What's good. I'm not going to belabor the time anymore. Because I want Miss Horn to really enlighten us with her knowledge and everything, and I'm gonna let her introduce what she do and introduce herself. So without further ado, let's give a round of applause for Ms. Horn. Come on, hell everybody, Yes, thank you so much for the warmer introduction. I appreciate that. Thank you. Miss Gray, you know, invited me onto the show talk a little bit about, you know, my experience that is in the day to day setting that I do now as my career. But I'll give you a little bit of a background and how I got to that point, right. So, I actually started out at Valencia College. For anybody who is looking to put their kid in a four year college here locally highly recommend it. I saved so much money.

5:27 I had very small classroom experience, which I think really did help like bolster my knowledge right, especially with these core classes that led into me getting to UCF as a biology major. I did graduate with honors, and I think it was around the last year or two that I was there that I actually went back with doctor Latrell, who was my father's pediatrist at the time, and spoke with him and said, hey, you know, I've been trying to get him anywhere to just get shadowing hours to try to get my foot in the door. All these hours are required because it come on in. We'd love to have you right, lovely family. Of course, I know now, great crew, very accepting, very wonderful learned under him, and I had been with healing souls paedietry now since I guess that would be twenty eighteen, which is kind of crazy to think about. Did take a two year hiatus for you know, Ms Grayno's some some family problems that I kind of needed my full attention. But very happy to be back, and you know, the knowledge that was given to me obviously is still very strong in my heart.

6:26 I'm very passionate about patient care and longevity and you know, going further than I guess you would say clinical care, we really do care about every single patient that comes to that door. I specifically love research, so even one of my closest friends that I used to work with at the Valencia College biolf because that is also in my resume history, if you will. I did work at the bioprep lab at College too, which kind of helped with some of this research and clinical coming together. But yes, I'm very passionate about research as well and bringing some new topics to the table. Sometimes of you know, sometimes you can get discouraged and think that there's no options or eve been turned out by so many other physicians who have said, you know, here's your one option and there's nothing else that you can even try, and I just I do. I love that doctor Latrelle looks at different different scopes. I think him and I align very well with that, and yeah, unfortunately, we we do deal with I think some of these topics at hand which we you know, we'd spoken about amputations and vascular disease and diabetes, trauma, different things like that. And I think Miss Gray and I have had a lot of conversations.

7:32 I've had many conversations with other patients as well about you know, the physical aspect of it of course, yes, but the mental and the spiritual side too. So yeah, I think I think that's what brings me here today. Amen, And we and I love Miss Horne because you know, the whole staff is just so open and receptive and they move along with you know, they recently saw me have a moment whereas kind of broke down, just couldn't take you know, this health stuff and going to get the blood work and going to do this and going to do that, and it just it really I've never have gotten overwhelmed in my personal life since I've been in the hospital and over these past seven years of going through what I went through.

8:12 But I'm telling you, it's. Good to be able to, you know, be relaxed that there's no judgment there. They accept me as is, and like I said, he's one of my healing. Healing Souls is one of my leading sponsors. And the staff is there. We've had a luncheon there and everything else and they're open for everything. And I'm glad miss Horn made it back because she was missing and there's a difference there, you know, and everything. And she comes in and she meets with the patients first sometimes and she's getting up more of a history and everybody there knows your history. All the staff knows your history, and they know you. No judgment is best. There's Charles coming in from Washington. Hey, thank you. They're gonna be everybody.

8:55 It welcomes people, it does Charles, and it keeps you there, it keeps you going back, it keeps you feeling okay. This is truly a safe space, you know if I you know, so whatever the and we can talk about everything, We can talk about anything. So you know, I'm just it makes a difference. But I'm glad you touched on one thing and I'm going to start opening that up you Finally, finally, people are identifying that once you're starting on that road of limb laws, that you're going to possibly lose a limb, you're going to be amputated. The front part of that most people think is diabetes automatically. And my story, part of my story is and I think I put it. I listed it in the book that you know my doctor, Lettraill, my surgeon said, you know, they wheeled me in.

9:38 I already had the amputations of. My fingers in my hand, and so everybody's like, oh, what happened to her? And he's like, you know, he's trying to think, like, you know, how do I And then he had to finally quiet the area, said just I got to give me a minute. I got to sit here because I don't want her to have the limp. I don't want limping. And I tear up every time I recant that story, because that's who I'm talking about, with this organization, with this doctor's office. He was like, no, everybody out of Eachell'll be quiet because I got to think. And he's like, okay, okay, and he proceeded on. And so I know my angels are in the room with him as well, and he's just one of a kind. And I look at but going back to that, it's not only just diabetes. We now have sepsis. It's coming up and reoccurring. Now it's becoming just almost as frequent as you hear diabetes being the cause. Then we've got people with the smoking and alcoholism and having a cardiovascular But the newest category that people and I call it, it's not really new. It's been there since we've been since the world of amputation. But nobody's talked about it because you're already making a judgment. You're already assuming that you know how we got to hear. But there's the trauma.

10:53 And lately I've been training with gentlemen, and I mean and mainly some men who too, what is that sepsis? Okay in a stage I'll circle back in a minute or either. Miss Horn could also help us with that. But let me say this part and then Miss Horn, I want you to jump on in. You know, trauma. There's two young men that were hit on their bikes when they were fifteen. They're now in their thirties and forties, and their limbs had to be amputee or they limb had to be amputated. That's a trauma. That was no diabetes, that was no sepsis, that was not they were smokers, none of that. They got hit by a car at fifteen and now here it is they are now an amputee.

11:33 You know, there was one that had an accident on the job with a meat grinder. Things happened. I remember my dad, we were we got the call. He used to build houses and we had to go to the emergency room because there was an accident. They didn't tell us, and we get there. My dad's you know, he's bleeding, he's got a gauze on it. But it was this thumb this, I mean that thumb, this finger here that because he saw ricocheted and cut his finger. So not this. I'm just getting a revelation. My dad became an amputee. I didn't even think about that. Oh my god, because I'm seeing I'm having a picture of him. So so there's that, there's the medical pieces. There's the uh genealogy. You know, if you've got diabetes in the family, you just can't take that lightly, you can't.

12:17 And then childhood diabetes, and I know you all don't see children, but that's another big issue that people are. Not thinking about. This is serious and that child could eventually lose a limb at some point in their life. So miss Horn, I know I've said a lot. But yeah, Litsten from the beautiful set of folks. Uh, you know patients that you all have. I know, we all have a story, our story. You know, even if you've got two diabetics and you've got three cardiovascular you know you got one sepstance. You know, we all have a story of how we got to this. Yeah, definitely, definitely. I mean, just whatever's on your heart, whatever you think the audience you guys, I'm sorry, Trey.

12:59 Can I ask a question into a mishorn? I just thought, so, what about if someone has like a bite, an insect bite or annal bite, an allergic could that result in ampute? Definitely, definitely. So it kind of runs along that same side of sepsis. Right, So, sepsis can happen from either a wound that has become so poorly infected that it has not entered the blood stream. And the biggest problem is if we're concerned that it can enter the blood stream, it is safer to amputate the digit the limb than to allow potentially the whole body to shut down. There is also the side of sepsis where you are experiencing such a severe infection that unfortunately they have to basically put your body to sleep, put you into an induced coma.

13:44 In worst case scenarios, they will give you something called vasopressors that basically constrict all the vessels and the most small furthest vessels which are typically in the hands, the feet, the lembs, to keep the core alive. And when that happens, it does result in them law. And it happens more often than you would think. And I will say as well that I am unfortunately was guilty as well. With miss Gray. I look in her chart and I go through every patient's chart and I seen non diabetic. I'm like this, that's good mistake. You know, everyone has hard days. She just didn't want to felt this part of the paperwork. And I go check with with the doctor and he says no, And mind you, this is this is earlier, very early in my time as well, still with doctor Latrell, and he's like no, and we went through the case and I was like, oh my word, I had just never heard of an experience like that. Yet right later now we have experience to her point. I had a patient just the other day that unfortunately did have a traumatic loss of their big toe just from something falling at their work and it completely amputated the digit. So traumatic loss is absolutely something that I have seen more and more in the years that I've worked there. As well.

14:48 Car accidents as well is something to consider because unfortunately there's times where you know, I don't want to be too graphic on here, but you know, nothing's disconnected, but everything is so shattered on the inside that it's irreparable and the only option, unfortunately, is to proceed with amputation. So I do think there are several so many more cases besides just the cardiovascular disease and the diabetes. I do think unfortunately, it is still a predominant leading factor. I think there's a lot of new medications on the market to help diabetes in there, especially with patients and the lifestyle changes right, a lot of it's very difficult, and you know, medicines that can aid in that, even if it's just a crutch for a short period of time.

15:30 Some of the things that they've come out with has been very helpful. So, you know, I hope that in future studies we're going to see a decrease in that. You know, you've seen that the newer generations are smoking less and things like that, So same things. You know, we all have hopes that those statistics will continue to decrease. Right, but yeah, yeah, and you know, two things that got out of it was I'm wondering what vaping is going to show us. Yeah, I wonder what vaping is going to because that's a different animal there, and the different dependency and everything else. I'm giving it a few more years, we may start seeing and hearing you know, the whole new set of batch of research you know, on that and everything. I was very blessed. Basal pressers were when I was was administered to uh while I was in surgery. And yeah, that that there you go.

16:21 And it's sad that while we have snake venom antidotes, we don't have an antidote for something like that that takes the blood like you said, but it don't put it back. There's no medication to put it back. And so that's that's that's my story. So and and that one thing I've shared with you all over over the years that one of the receptionists uh uh in the early years I was there, she at Halloween time, she had two bags of candy. One was for everybody else and one bag was for me and she put my name on it. MS Gray is not a diaper, Yeah, exactly, the sugar free candies. And I will say that, like, you know, if we are talking about wind care, amputation, limb loss, et cetera, it is a vast majority of our patients that are diabetics. Some I will also mention as well that can kind of be forgotten is unfortunately, cancer treatments, such as radiation, there are secondary effects that cause lesions on the skin, especially the feet. So we definitely had patients as well that had no vascular disease, no diabetes, no trauma, because I do consider radiation trauma, but they did have massive ulsters to the feet and unfortunately, just like in type one diabetes, being an autoimmune disease and unfortunately causing you know, your immune system to be lowered in general. You know, with this with the cancer treatments as well, your immune system's lowered, so everything heals slower, everything is more difficult, and that can also lead to limb loss. When we talk about sepsist, God forbid the area, this open area that we're trying to heal for sometimes

17:52 years at a time. And I'm not exaggerating does not get healed, it gets infected. We are just playing a game waiting to get a bone infection. And you know that's our goal really weekly with those type of patients is to mitigate infection, try to keep it healing, make sure they can still keep up with their treatments, and hopefully at some point in time be able to really tackle this and totally heal the wound up. Is there a way to save a limb before having to remove it? There you go. So I actually love that question because I like to say we are in the game of saving limbs. You know, I have several several patients that will come into the office that were greeted by a more brash person, let's say, an er who is a general doctor and says, oh, well, you're just gonna have to have this amputat whatever that may be. It may be a toe, maybe a leg, and it'say it nonshot like that, like it's not life changing, like it's their only option. And thankfully, I always get sad thinking about the percentage who do not, But thankfully a lot of these patients will advocate for themselves to have a second opinion, and anybody listening, I would always advocate that, just like if you have a construction worker come to your home, you should have three quotes, right, You should definitely advocate for a second opinion, especially if you don't feel like your question are you know, properly being answered. But we've had several patients who have come to us and maybe it does take several months, maybe even years, but we absolutely can save a lot of the lembs. Unfortunately, it just comes down to how repairable the damage is. Bone infections are very difficult. We can always try IV treatment of antibiotics. Sometimes it works, sometimes

19:22 it does not, and you know, we always just pray that it does, of course. But yeah, there's there's definitely different options. Are there options at different times? Yeah, so depending on the stage that you are in of course as well. So she spoke of different different things that are happening here. So if we're talking about a vascular disease, unfortunately that is the most common one that will inevitably lead to an amputation. And why is that so? Vascular diseases are literally depriving the furthest parts of your bice your toes, your fingers of the oxygen that it needs to be able to keep those cells happy and alive right over time, the cells will just die off, the tissue will start to die off, and at that point it does hit where there's no coming back. The tissue will not rejuvenate once the cells are fully dead. So, unfortunately, you do kind of weigh the odds of moving forward an amputation in these worst cases not moving forward with an amputation, because your best option would be what's called an AKA, which is above knee amputation, where you're all the way up at the thigh, and that's just because that's where their nearest good blood flow is.

20:31 Right. So if we let's say, unfortunately, have to amputate a limb and we start to do dopplers and see that their blood flow, you know, we only needed to amputate the dead toes, but their blood blood flow starts well below the knee, we have to do a blow knee amputation instead of a TMA, which is considered a trans metatarsal amputation, meaning you would take all the toes off and leave that portion of it. So it really does depend on the scenario. Vascular is the one that I would say, unfortunately, is the most bleak as far as if it comes in in a very dire state. There's usually not a lot that we can do, but there's a lot that we can try to do preventatively before it hits that point. Yeah, and having conversations like this in the schools. We need to, you know, we need folks going in to talk for the prevention because we've been so far away from prevention since I'm gonna say since almost since nine eleven and even twenty twenty, you know, because we don't talk about how to prevent something. We're already we're trying to you know, put the fire out in crisis mode or and not even early intervention. Trey, you remember, Trade was from my I met her in my hometown many many years ago, and she did domestic violence work. Remember, we always talked about the prevention side of things. We had grants out there that were for prevention only. That's pamphlets talking to people, educating people, you know, almost scaring you to death. Was with the stats to let you know, so no, if you see something, all y'all, if you see something, say something, you should have did that fifty years ago.

21:57 We talked about that, seventy years ago. We're not that old though, but anyway, you know, I mean so we now we're not even That's what has concerned me about my field of social work and even in the medical field, that we don't talk we can't even talk about prevention anymore because we're already way over here. We're in intervention and crisis, not even early intervention. So having conversations like this, having our younger people hear this, having the parents to have a conversation and say, you know what, there's diabetic we have diabetes in the family, or we have high blood pressure in the family. One other gentleman that was in I was in the training with he stepped on a nail. He's a police officer, he is fine, no health issues. He stepped on a nail which went through his steel toe boot and the foot got infected.

22:44 The toes got infected immediately. You know, just even the frost bite when people go up north and they're climbing mountains and stuff like that and they're not warm enough and stuff like that, that frost bite. You know, you got to have this conversation. And I don't I want you, you know, I want you to just understand and the body, now this is gonna get you. The body was created to heal itself. It was created to heal itself if you. Do it right. But you got to tell your body you got the line up. You know, you're supposed to heal. You healing this wound. I remember being a discharge planner at the hospital and I told you, I shared the story all the time. It was a slightly very obest bus sized woman who's who her kids had set her in a lazy boy chair in front of her bathroom and she would have to get up and try to hobble because she was very old.

23:32 Wait, so she breaks the femur. She breaks the femur. Well, we can't there's no bone getting the bone. Back together, you know. And medicare says, well, no, she's on observation because there's nothing else the hospital could do. It had to heal itself. A bone healing itself. So I want people to understand that no matter when you go to the doctor and you're hearing the diagnosis, you're getting the lab results. Okay, listen for those results, because that's how you you you you you formulate your prayer. Lord. Right now, I bind inoperable diabetes, let it go no further, and whatever medications I'm prescribed, I don't want to be on it long, but let it hit where it needs to hit so I can be better and learning and educating yourself. So I'm glad we've got some young folks also listening in, you know, because you got to I know, the French fries, I know that the chicken nuggets McDonald's is not sustaining food anymore. It's not good stuff going in it anymore. It never really kind of was y'all need to get you to tell your parents to get a small little grill from Walmart y'all burger, you know, cook the burgers, grill the burgers and hot dogs in the backyard. Okay, do it yourself and not you know, going to these places and and and getting this. I know, fast food is just that it's fast food. But over time, and I'm just gonna be really uh uh, just really transparent.

24:54 I was very healthy meeting with this great treatment team I've got here, my medical team, very healthy going along. But then I'm like, oh, well I could just have a little pepsi. It won't hurt, and a little PEPSI got to a six pack and an eight pack, and I went to drink up every day. But then I had my sweet tea and slowly, but surely, all of a sudden, the lad results came back and said, oh, it's great you you. Not no longer bought a line diabetic. You're diabetic. And I'm like, what, No, I went through No, I can't be. Yeah. Then I had to put this gookie device on my arm that reads my sugar level and report it every day. And everything I'm except for water it's got a little sugar in it, and my numbers are all over the place.

25:37 And I'm like, oh, no, no, no, I can't go back in the hospital. But I had, I was. I was self sabotaging is what I'm gonna go hard on myself. I'm not saying other people would do this, but yeah, you know better. And I'm not out of the woods because now I'm I'm free. I'm already pre I'm already pre this. This opened up that door because you know, miss Horn and my saying it right, No, I rotted myself up. No, No, I definitely think what you're saying is true. And you know, unfortunately, when we talk about limb loss, we've had this conversation of the mental aspect of it. We are reaching for comfort that we have lost right and I do think that many people do that. And one of the cases that I see the most is, you know the way my grandfather used to say, you know, burying your head in bed, meaning you go to bed and that is just your comfort place. You find that you know, you don't really want to do the pet and you're you're really not wanting to cook it home.

26:33 You know, you're really not wanting to try new things. And I'll be honest, I can think of maybe one patient. He's actually a double amputee. He got them both at the same time. He got fitted for both lights. He jumped up and was ready to walk. He is somebody that was just driven from day one and was like, well, there's no other option, so I'm just gonna do it. And but he was a rare species, if you will, right like, that is not the commonality. The commonality is to be terrified knowing my whole body could die, could shut down, and yet I need a day or two to think about maybe if I need to amputate this one. Right, And this is coming from a team that they trust, someone like us that potentially has tried to mitigate that problem for whatever given amount of time. So you know, it's not that they're not trusting it, it's that their brain is going, is this for real? I really have to mentally disconnect with this as well. So I do think, like you know, to your point of a diet pepsi or a pepsi or a French fry, even right a drive through whatever, it's it's that that little bit of I deserve a little convenience, right, Have I not been inconvenienced enough? And I think it is an easy trap to fall into because it does kind of start to fall down that let line of like pity me, and well, maybe I should just stay in bed today. And you know, my pet doesn't know everything I'm going through and it is too hard to dad, and I'm just not gonna do it. Instead of telling your brain, hey, hush, you're gonna feel better if we just shut that off, if we quiet the noise a little bit, we go back to our prayer, if we go back to our pete, and we put in the effort, and maybe we can't do all ten exercises, right. And I tell my patients this all the time. I was like, but if you did three, it was better than the zero. You were first willing to do right, like actually push to find

28:06 what your boundaries are. You know, same thing with the you talk about diabetes and changing foods. And I have so many of my patients that, unfortunately, like have never even had a good talk with their doctor. And that's another thing I would I would play off to your point is ask questions to your doctor. Many doctors, unfortunately, are going to sit down and give you some crazy diagnosis like diabetes, right and think, oh, this is so generalized. You're a diabetic. Here's the info, here's your packet. You're gonna get a pamphlet, pick this up at your pharmacy. They don't know anything about the dietary changes. They don't know about panting their carbs. They don't know how carbs simple sugars versus complex sugars, you know, affect their blood sugar spikes versus longevity of holding blood sugars. And what I always and unfortunately, those are the patients that come to me frustrated. They're ticked off with the medical industry.

28:50 They feel super confused because their sugars are all over the place. They don't know what they're doing wrong. And what I always tell them is don't be discouraged. Everybody has been at that point before. If any doctors ever made you feel belittled, I ever made you feel like, well you should just know this, then they're rude, right, they're not respectfully. Their bedside manner isn't good. And I used to joke and those people should be in research, right because you're smart, obviously are you got somewhere, But maybe you're not a people person and that's okay. But yeah, I definitely think. I definitely think it's something where maybe you have to spend the day, maybe you get down with family, maybe you do some googling, and you come up with some questions where you know, respectful, you hold that doctor's foot to the flame they're billing me for. And I promise you they are that full hour that answered all questions patient asked, you know whatever in their silk note, I would say, ask them, ask all the questions, and if you don't feel satisfied with that, give a second opinion. And I know people hate the thought of starting over, but I would definitely.

29:41 To push you a little bit more each time to get further. Well, yeah, mister, you got to ask the questions. Now you can't you have to watch how you eat, make some changes. Yes, Mickey, you know you got to ask the questions. A good professor, a good teacher in your lifetime, will say, do anybody have any questions? I just gave you a whole lot of information the night, taking notes and everything. Anybody got any questions? Because we got a quiz coming up, or you got your major, we've got the midterms coming up, any questions? And I used to tell my. Students, don't leave me confused. Don't leave me because don't because you don't ask me the night of the quiz. You know, because I'm gonna give you a pop quiz. I gotta make sure you're with me and that you understand the material. Not just if you could define something, I need you to understand it.

30:22 So, no, I want to know. So when I go in and have my blood work read with my primary and she's very she's an arn she's very good. She goes through. She don't just run it and look at the numbers, and then she comes back with the lecture. No, no, no, she goes, Okay, mis's great. Here we go, and I got my copy too, and I'm going right along with it. She's going line by line. Okay, this is good. The numbers are improving. This is good. So I see you doing this, I see you doing that. By the numbers. The numbers will give you up. Yeah, the numbers will give you They will tell it all. Go ahead, Trey, you want to say something, Yeah. I'm just just having and MICHAELA. I know you're in the medical field. So one of the things that I learned about being a caregiver, sometimes the person that you're carrying with, like I was, might not know what to ask.

31:07 Correct he was. Older, so some of the things he might not have picked up on, Whereas when I went with him or my sisters went with him, we would ask those particular questions that he might not think of the one thing too. A lot of people are intimidated by going to the doctor. But I have some people in my corner that if I'm afraid to go, will go and assist me in there, and would go in to help advocate, because sometimes you miss things in a bit of nervousness and anxiety, and anxiousness can ask you know. There are certain conditions as well where people are legitimately not able to advocate for themselves, whether that is unable to speak physically literally does happen unfortunately we've had that happen in our world, or if that memory care issues.

31:54 They don't even know if something was missed what the doctor said. I have one patient who will call his wife every time he's in there. That way she can hear everything that we discussed, and there's no question nobody's missing any information. So I can I completely agree with that. Definitely, there's something to be said about the fear of advocation and just not knowing this of it. I'll be honest for myself if I have a patient that I can tell is a little timid. I've actually had a conversation recently with a bachelor patient and he expressed to me his concerns and he expressed to me all the questions he had, and I said, you should write those down right now, and if it makes you feel better, tell them your Podietri just wanted to know this when we were talking with the PA dietary and conversation. You know, I'm always happy to be the advocates d the fall I've I've already told you as well. You know, if you ever just need somebody in your corner to answer questions.

32:39 You want someone to, you know, help you with any of the insurance stuff. Right, our front desk lady is wonderful with that. Any questions with boond Care, they'll text me. There's a voicemail, right and we do try to bridge that gap. But I agree with you, unless you are reaching out to social work, which I always recommend as well, insurance companies a lot of times will cover social work. Yeah, there's definitely wonderful option. Yeah, you could do that, Mickey. You could say, hey, do you mind me? I just have to I want to record the questions I'm asking this, and you could I'll just and we'll just cut it off afterwards. But I just have five questions I need to ask and you're looking. You have that right and you have that time in there as well. You need to do that and advocate is nothing like advocacy for yourself. I think that was the biggest thing that really helped me together on a daily while I was in the hospital. I told them what I needed.

33:30 This is what I needed, a discharge plan with a social work background that only he or she will understand what I'm about to ask her to do. And I had three you know, three major things, and she was right on it, didn't I mean even reached out and stepped out a little further because she got to know our family dynamic and what my needs were. So yeah, you know, you could ask the questions and if they don't want to, if they like want to give you a. Brush off, then they're not the folks for you. And I could tell you that, I will tell you that I will come and advocate with you. I'll be on the phone that I have no problem with that because I will ask the questions. I will tell you the questions to ask. Okay, So but you have to do that so you can have a peace of mind every day despite my you know, trying to just get my head around what was happening to me because they still hadn't said sepsis yet.

34:17 They still hadn't said that because I was in that three week cooma, So you know, I'm waking up. What have you done to me? You know, and they still hadn't said that to me, because like I said, what have you done to me? What happened? And you know, later on I was able to see it. In the progress note Now I I we got portals, Now you have medical you know patient portals. Now you need to sign in, do your password. Go in there. You got all your test results, they're right there, and it'll say abnormal, it'll say red, it'll say borderline, yellow, caution. Some of that you can read because you'll see your prior number and you either went up or you went down. Some of that you just got to sit tight, copy it, you.

34:58 Know, print it out and and go over and say okay, and then highlight your put a question mark and take that in with you to your doctor's appointment. And I got some questions. Can we go back to the lab work? Okay? Sure, they have no choice or they lose a patient. Done, and we write results, we write evaluations, and I'll tell people something, don't send me. You know, they'll be kind of cocky and they'll throw all So, just don't send me an evaluation. They're like, oh, oh yeah, don't send me. If no one could go with you, for sure, record the conversation and go back over with your trusted people and talk it over with the team on the next visit. There you go, Missy, you're doing our job for us. Missy, I think you're a social worker underneath there. I think you are anyway, But yeah, thank you, Okay, ms Horn?

35:39 Is there anything else? We are we because we've got a buried age group that listens so and and I love our children. I love our youth because they take the questions, they'll take the conversation back to their parents, and so it's anything. Is there a prevention piece out there? Is there something we can say to anybody who right now, you don't have those issues, You've not been you don't have diabetes in the family, You've not stepped on a nail. You know, you're not being hit by a car. You know, you don't have any trauma going through something pending. But if something happens, of course, depending on what it is or was. Where do we go from here? Now?

36:19 Yeah? Where we go from here? Yeah? So that's I think that's really good. Yeah. Sorry, no, no, no, no. What I was mentioning because we're coming up on hurricane season and I wanted we're coming up on a hurricane season and I've seen where places have maybe flooded areas and people are walking through the water, and so I wanted to bring that up. So maybe michaela can touch on that as well. You know, you don't know what you're walking and you don't know what you're walking on. So just that's something I thought of. I'm sorry, no, yeah, yeah, definitely. So to that point, there's actually a couple of risk factors involved in that. Let's talk about a healthy individual, right, no pre existing conditions.

37:02 The biggest fear is the people who are trapped in water places where even the water is let's say, just past the toes, just past the toe line, it will hit the point where it is so moist your your base skin layer will start to kind of separate, like we get a blister. The problem with that is our skin is the most amazing protective organ. It's the biggest organ we have. If you don't know your skin's an organ, that's a fun one for the kids, the biggest orgon on your body, right, and it protects it's the best part of your immune system. Unfortunately, when that breach happens, which a lot of our patients is what we deal with the breach. When that breach happens, the body's very good. As Ms. Gray spoke about healing itself in the right conditions, right, we keep it in these moist conditions, We keep it in dirty waters and dirty bacterial conditions to your point of you know, it could be something very small, some branch or bit of debris, or you know, you really do never know what's kind of floating in those those darker areas, or how deep the water is, et cetera.

37:56 You could scrape yourself. For one of my patients, my goodness, I joke about that, they could just scrape themsels, right, And because of the lower immune system, the infection can be unfortunately, very bad, very quick, and we always hope that it's not and we try to jump on it. I mean, we are people who will literally take a text message over the weekend and prescribe antibiotics because we're like, oh, my goodness, no, you're right, this is a problem. Let's let's go ahead and jump on it right now. So I think early prevention is very important as somebody who you know, I'm healthy and I'm very blessed and thank the Lord, but definitely go go to the doctor. Go to the doctor regularly. That's something I neglected a lot in my youth, and that was with the father who had type of diabetes. Right. So definitely, if you have history in your family, you know, advocate for yourself. I know that there are some tests and scans and things that get added to your blood work only at a certain age. But guess what you can advocate for it. You can say, hey, I want the full, full, full panel, and when they're like what do you mean by that, tell the doctor, well, what do you mean? What's the what is the most I can have done? I want every single thing tested that my insurance is willing to test me for, right, And if you feel like there's a concern outside of that, then ask for that too. See what the price. You'd be surprised sometimes, but I think nothing is worth your peace of mind, right, So you know, doing that research, asking those questions, and you know, to your point of the flooding, being aware of your surroundings. And I hate saying the word common sense because some of this is not a choice.

39:14 Right. We talk about people whose homes are flooded, and I think sometimes when we think about floodwaters and injuries that go with that, we're thinking of the people out there and they're kiak, you know, screwing around in the streets. But the reality is the injuries can happen very likely in the homes too. And you know, I think the biggest thing for me and paid to be that lame person, is get out of the house. All the things in the house are replaceable. You're not replaceable. If you are financially able to if you have a friend, if they can make it to a shelter, you know, get to a place that's safe. I think that's always a big thing for me. I can tell people to be careful in the snow cold. Many people go to play and ski in the winter weathers, but they are not used to that kind of cold, and they have many they have issues not knowing how to prep for the type of cold that they have never been accustomed to. Very good shows, very good. The results a Florida winter clothing is nothing. We can't even go to Georgia. To go to Virginia and the cold, that's nothing. You've got to go to those states and buy your clothes there. Because our little, our little sweaters they're very thin and all that kind of stuff. They do nothing. They barely keep us for them. And we're in layers here in Florida. So you're that was a great point, Charles, Thank you for that. And you know, and we've got critters. Now, we've got critters just showing up from nowhere, mixed breed stuff. When I moved here, I was here and I went over the city called Castleburry to meet with a colleague of mine and there's this big thing and I'm like, what the devil is that?

40:41 And he was about this law, and but he was different colors. I said, I know that can't be a grasshopper. I'm only seeing green grasshoppers. I've never seen even seen the brown one. But this was multicolored. And I'm like, wow. So you know, you're stepping on stuff. And you know kids out there, kids red alert, do not be picking up animals and rollers and stuff like that. You don't know what they're carrying. And don't just go up to a dog even you don't know if they've been vaccinated, they've had their shots and stuff. Now, that's one creature that has to have shots. Okay, that's one, all right. You don't go and be trying to put you know, you know, pull their tail or whatever. You don't know. If they've been well kept. You've got to just take precaution.

41:21 You don't I'm not saying it become a prisoner and all of a sudden, oh, oh my god, I'm this is not fear. This show is not to instill fear, is to alert you, is to make you aware, and it's to hold make yourself accountable. You've got to hold yourself accountable and to your because of your animas. Let me tell you this, Well, and that's great, you are so correct. I cannot tell you how many patients came in with the misnomer of well, dog's mouths are cleaner than humans. Right, And what I'd like to always express to people that we tend to forget. And this is going to go with a couple of scenarios I'm going to give you. Okay, animals carry different bacteria than we do. Right, there are different species. Things like that when that bacteria it gets into our body, it doesn't know what to do with it. It's something that's a brand new infection. And those are the ones that become so severe so quickly. Whether you are a healthy individual, and then god forbid if you are someone who has compromised.

42:10 Right. My other favorite point to that is pools. Right, I can't tell you how many of my patients with a wound or like I can't get in the pool. It has all this quarraine I can't get in my tub. I cleaned it with bleach. And what I like to express to them is, you know, my micro microbiology class, what we would learn is, you know, in those environments where bleach has killed everything, there are other bacteria that are still surviving. So think about that. In a pool that's fully chlorinated, in a tub, a shower that you've you've completely cleaned down, there is bacteria. And it's the bacteria that survived that you know, point zero one percent if you will, on the bottle that survived, and that is the bacteria that you just you do not want to be infected with. And so unfortunately, you know that means we do have to sacrifice parts of our life.

42:55 So you talk about you know, unfortunately we're talking prevention to limb loss following your protocols. I have so many patients that are non complain and I'll be honest with Gray, was never that patient. You know, not to toot your horn, but there's always very wonderful and goal oriented on I want to be better and whatever way that means physically, spiritually, mentally right, I want to be in the right place. And unfortunately that's that's not always the case. I have patients you know that will ask me why their wounds aren't healing and then tell me they just did a full day at Disney and didn't want to use a scooter, you know, because it's just it's not for them. I'm like, it is though, unfortunately, No, I know you want you're a martyr and you want to give it up to everybody else. But get on the scooter, right, So, you know, being willing to listen to those protocols and make little sacrifices now, I know, like we talk about diabetes, it stinks to have to go to diet SODA's or to go to you know, reduce sugar, this Keto that. But you start to make those small adjustments and you'll find you might really like this brand's you know, keto bread.

43:49 And you come to find that this alternative of how you cooked, you know, your breakfast isn't that bad. You're just leaving out the toast or the potatoes or you know whatever it is. Right, And I'm a big fan of finding exchanges. I'm someone who diets and exercises as well. Right, find changes in your life that you can stick to because you actually enjoy it because it was something where instead of seeing I can't have anything, I can have a little bit of something, right, Because imagine that's the only other alternative if you're trying to live a healthy lifestyle is nothing. And I encourage you to find a balance because I promise you can. You know, it doesn't have to be all or nothing. There's there's definitely a middle ground and good days and. Bad days, you know, man, thank you so much for that. This is this is this is why you know we're as we're honoring and recognizing and acknowledging limb laws and limb difference.

44:33 You know, because there are people who were born with no limbs. You know, they still have to be extra It's still got to be as careful, you know, even though they were born with this situation, they still got to maintain so it won't get any worse. But please, if a service animal comes up to you without an owner, please get more people and follow the service animal. It may lead you to the owner who may need to need help, but never follow and think without another person. Be safe. Thank you, Missy say I love my audience. We love our audience. They so awesome and they think about these things because normally nobody's gonna think about that. Nobody's gonna say that, you know. But yeah, we got to be very careful and you've got to keep your head on a swivel. That's all you have to do. At the same time, you've got to put your self care techniques and protocols in place as well.

45:16 You know what do I do? What do I enjoy doing? You know? Okay, I'm not able to do this right now. And that's one thing in this world of amputeeism we've all been able to say once we once. We have some time, because we have to have time, we can't you can't rush us into things. But once we've had time, we can say, you know what I get I think, you know what, I'm gonna do that. And sometimes most of the. Things I've reacquired that I didn't have to relearn I wasn't thinking about, Like, okay, today, I got to be able to put my earrings on. I gotta do I wasn't doing that. It's just like, oh, you know what, I can't wait for the kids to get up to me. And it was a hoop earring and you know, with a little hook, and I did it. I was like, you know, and we have those small celebrations, you know.

45:57 Because I did it, I didn't have to ask for help. I got up there the morning everybody, you know, my daughter was at school, and I'm, oh, my baby just came. He came in from overnight work and and I think my other son stepped out or he was snoring, he was sleeping. I said, I'm hungry. I can go in there because miss miss Kay has put things in tumbleware and stuff like that meal proportion and stuff. So I said, oh, I could get this very carefully because my dog is sitting there waiting. For the scrap. That's what she does. I'm something's gonna you're gonna miss something. I'm gonna get it, you know. So I said, go out the kitchen. Get out of the kitchen, you know. And I just took my time. Later on, okay, young had a young both. Be imputated this weekend. Oh wow, Well the cave that's out of Tennessee, Oh my gosh. Okay, Well, if he needs support, if he I don't know how old he is, but if he needs someone to talk to, give him my number. Let me let me walk him through this, because that that's that's a throwback right there.

46:53 That's I'm I'm I know I can't see my life. I can't even see my life, you know, and what life could be like. So I'll be more happy to take some time and talk to him, you know, when he's ready. I don't know how old he. I think she's just he was sixteen fifteen. Yeah, So if you needs somebody, if he's ready, when he's ready, and he has to be ready, he can't force us. We got to be ready to hear the conversation. I know. My prosthetic company, you know, my technician was like, okay, hey, mss Gray, I think you'd be this. I said, no, no, no, hang on, just hang on. I'm not walking around with hooks. I'm not doing that. I'm not doing it because I'll pinch myself and then I'll be mad at you. And won't talk to you anymore. You know. But I had a great team because they're like, okay, this, Grace says no. They knew when to back they know when to push me, and they know when to back me, back off, and they do it so they don't have to back off because they're like, hey, it's great. You know I was thinking, especially miss horneshit. You know, I was thinking, so what are you doing with this? How are you doing this? And very you know, and I love her for it because it's like, you know, I didn't think about that, or you know, what I'm doing is this? There you go and they celebrate you, they celebrate your wins and everything.

47:56 But anyway, we got less than a minute to go. Any last words, he any last words the audience anything, This is great, This is great, and thank you so much. Doctor Littrell will look out for you. This is pay She's working for fifty minutes effort, so please make sure that the paycheck reflects that. Okay, actually his birthday tomorrow? Really, yes, okay. Today's sure bout it much information, good things, ladies, Oh thank you? Okay, So tomorrow okay, okay, And tomorrow is a Tuesday in office. Okay, I got a surprising whoo boo. Well, thank you so much. That's our time and we'll see you next week, same time, same stay shine night night y'all. Thank you, miss Hards