One of the hobbies my wife and I have is gardening. Even though it is getting more and more difficult to keep up with it because of my escalating conditions, we’re trying.
I have noticed on our local Nextdoor several different people on different occasions asking where they can purchase homegrown tomatoes. My suggestion to them and you is to grow your own. We have had ripe tomatoes from our gardens on the table since late March/early April, and continue to have an abundance. We have also provided select neighbors with the fruits of our labor. I made the short video embedded below to “show you how it’s done,” so to speak. Enjoy.
Each person’s experience varies depending on their type of Neuropathy, but in general, the following are the most common Symptoms of Peripheral Neuropathy:
1) Severe strange pains in your feet, legs, hands, and other parts of the body; including “crawling insects” under your skin; Mine come and go
2) Balance is difficult when walking, getting dressed, getting out of bed, or whenever you close your eyes; Yes, I have this. My wife has to help me get out of bed.
3) Numbness / heavy / cardboard / heavy cement feeling/ Novocain feeling in your feet and legs; Yes, bottom of my feet at times.
4) Tingling or “vibration” like feelings in your feet and hands; Just my feet.
5) Electric shocks starting at the bottom of your feet/foot that shoot up your leg(s) and on almost any part of the body; No, not my trip.
6) Bone pain, especially in the feet on walking or standing; No, not yet.
7) Painful muscle spasms/cramps; Yes, all the time; wakes me up.
8) Skin may become painful to touch or lose the feeling of touch, with Agent Orange skin rash; Yes, loss of touch
9) Burning sensations in your feet and hands; Very few times, but yes
10) Loss, or lessening, of sensation for hot and cold; Yes, plus cold feet.
11) Feeling like you are wearing socks when you are not; Nope.
12) The feeling you are walking on crumpled socks or stones; Yes, a few times.
13) Feet feel swollen or large; Nope.
14) Difficulty moving your hands or feet; Feet, yes.
15) A feeling of clumsiness, tripping (foot drop) or dropping things; Yes, as relates to feet.
16) Attacks of daily severe exhaustion with strange fatigue; Exhaustion, yes.
In more severe cases of Peripheral Neuropathy, you may also experience the following:
17) Problems with not sweating in the lower body with excessive sweating in the upper body; Yes, upper body.
18) Digestive (fullness; alternating diarrhea/constipation) and/or urinary problems (overflow incontinence); Yes, fullness but could be do to IPN
19) Sexual problems (loss of sensation/feeling/moisture); Yes, no feeling.
20) A tightening of your chest with an increased difficulty in breathing and/or swallowing; uncorrectable vision problems. Not yet.
In previous blogs, we have discussed the recent Doppler and MRI scans that I recently had and what they revealed. I am in the queue to have a trial Nevro HFX implanted in my spine. The following YouTube video explains my underlying condition, Diabetic Neuropathy, and how the HFX treats the same. Watch it for more info:
Have a situation developing. We will not receive our IPN delivery this week because the prescription was changed as a result of my weight loss. Pentec, who provides me the IPN, sent a revised prescription request to my team/Dr, and to date, it has not been acted on. I have reached out to my team for resolution. Hopefully, it will be resolved sooner rather than later.
Yesterday, we reviewed the results of a recent Doppler Scan I underwent as part of a workup for treating the numbness in my legs. Today, we will review an adjacent MRI, followed by a blog on what is projected to be done about the numbness.
Below, I will first post in layman’s terms the result of the MRI that Perplexity provides, followed by an embedded three-page PDF of the actual findings for your comparison.
Layman’s version:
Thoracic Spine MRI (middle back)
No evidence of active bone injury or fracture.
Increased thoracic kyphosis: The curve of the upper back is more pronounced than average, which is common with aging or weakened spinal support.
Degenerative disc disease: The discs between the vertebrae in the middle back are worn out (“dehydrated”) and narrowed. Some rough bony outgrowths (“osteophytes”) and uneven endplates are seen—signs of arthritis in the spine.
No protruding (“bulging”) discs, no joint arthritis, and no pinched nerves: The spinal cord, nerves, and bone structures look normal.
Other tissues, blood vessels, and areas around the spine look normal.
No signs of cancer or other destructive processes.
Summary: The changes seen are typical age-related “wear and tear” (degeneration) of the discs and spine in the middle back, but nothing immediately dangerous or unusual was found.
Lumbar Spine MRI (lower back)
Age-related changes are present (“degenerative disc disease”) throughout the lower back. This includes worn-out discs, bone spurs, and arthritis in the joints between the spine bones.
Mild scoliosis: The lower spine curves to the right a bit.
Evidence of muscle spasms, with the low back being “straighter” than normal.
Hemangioma at L1: A benign (non-cancerous) blood vessel growth in one of the bones of the spine—this is typically harmless.
No evidence of acute fracture or bone marrow problems.
Nerve canal narrowing (spinal stenosis) and “pinched nerves” at several levels:
L5-S1, L4-5, and L3-4: There are disc bulges and joint changes that significantly narrow the spaces where the nerves exit the spine (“neuroforaminal narrowing”) and the central spinal canal (stenosis). This can cause pain, numbness, or weakness in the legs (radiculopathy).
No herniated discs or significant narrowing at L1-L2 or L2-L3.
A small fluid-filled area in the abdomen (“peritoneal fluid signal structure”) is noticed by chance and needs more scans (CT or MRI) to figure out what it is, but it may not be related to the back symptoms.
Summary: There are multiple sites in the lower back with “wear and tear” changes, some causing significant narrowing around nerves, which matches complaints of nerve pain. There is also a note about a non-spine-related fluid area in the abdomen that needs further checking, but otherwise, there’s no sign of serious bone disease or cancer.
Takeaway: Both MRI reports show typical age-related changes in the back with areas that could cause pain, stiffness, or nerve issues, but no immediate life-threatening findings. There is one unrelated area in the abdomen that needs further evaluation to determine its nature.
Lots of water under the bridge since my last post. In summary, after a Doppler Scan and an MRI, I’m scheduled for implantation of a SAS after getting checked out by a neurologist. In the next couple of blogs, I intend to fill in the blanks for readers.
First, the Doppler scan I had was from the groin down on both legs. Its purpose was to ascertain whether I have any blockage. I have embedded two pages of the report below.
A couple of items to note in the above Doppler reports. The increase in velocity through my vascular system suggests a blockage, as exemplified by the fluid dynamics described in https://en.wikipedia.org/wiki/Bernoulli%27s_principle. This is confirmed in the last sentence, which states that there is plaque present.
Plaque results in PAD, or Peripheral Artery Disease, a ramification of which is numbness in one’s legs, which is what I am experiencing.
Tomorrow we will cover the second aspect of my disabilities, that of lower extremity diabetic neuropathy, and results of the MRI of which I had two, one lower and one upper.
Yesterday, we had a visit from a VA social worker to conduct a home visit as part of the process to attain Caretaker status for my wife, who is acting as such. It was straightforward as far as the visit went. He asked a list of canned questions about my abilities to care for myself, and by extension, what my wife was doing to assist me. He took a walking tour of our home to check for safety-related items, trip hazards, in-place smoke alarms, etc. All pretty standard stuff; he found no items missing or needing correction.
We did pick up a few requirements we did not know about and other tidbits.
We must finish the online Caretaker course before our file goes to the final decision board.
In over several hundred such inspections, only two have been rejected at the point we are now at.
I am required as part of the program to travel to the VA in Ft Worth once a year to be reviewed by my VA team. It is a requirement to be in the program.
The VA will provide my transportation if requested for the meetup in 3.
We will be eligible to receive 12-17 respite hours per week for my wife at our request.
While we have out work cutout for us to finish the caregive course, the end, regardless of the outcome, is in sight.
Applying TAM, SAM, and SOM to the Indiana emergency responder training center concept:
1. TAM (Total Addressable Market) This is the maximum potential market size—all organizations in Indiana that could benefit from emergency responder training at centers like ESEC and similar facilities.
Includes: Every fire department, EMS provider organization, law enforcement agency, public safety department, and related entities statewide.
This encompasses thousands of organizations and many thousands of individual responders across Indiana.
2. SAM (Serviceable Available/Addressable Market) This is the segment of TAM realistically served by the Indiana-based facility, considering its regional location, infrastructure, and focus.
Includes:
Agencies within feasible geographic reach (e.g., within a few hours’ drive of central Indiana)
Organizations that need services ESEC provides (live fire, EMS, CPAT, SWAT, etc.)1
Agencies whose schedules and needs align with ESEC/IDHS/partner offerings12
Likely scope:
Central Indiana and surrounding counties’ fire, EMS, and police agencies, plus regional organizations that can travel to Indianapolis.
School systems, colleges, and adult learners within the region exploring public safety careers1.
3. SOM (Serviceable Obtainable Market) This is the portion of SAM the facility can realistically serve in the near term—factoring in competition, partnerships, and operational capacity.
Includes:
Agencies and individuals already training at ESEC or similar Indiana centers1 (program participant data)
Those actively marketed to, or under contract/memorandum with the center
Realistic growth targets based on staff, space, and logistics limitations
Typical scope:
Hundreds to a few thousand trainees per year, depending on class sizes, frequency, and facility scale (exact numbers would require ESEC annual reports or state aggregation)
Likely a subset of active agencies prioritizing ongoing skills development and proximity
Summary Table
Market Level
Definition
Indiana Application Example
TAM
All organizations that could ever benefit from the offering
All IN public safety (EMS, fire, law, etc.) agencies
SAM
Those realistically reachable/fit by the service/facility
Agencies within <~2 hrs of Indy with training needs
SOM
Realistically obtainable/served segment now or soon
Actual ESEC/partner trainees per year
In sum:
TAM is all Indiana-based potential clients
SAM is those the facility can currently target due to location/focus
SOM is those who actively use, or are projected to use, the Indiana facilities now or soon
This segmentation helps size the market and set strategic, attainable goals for growth and funding.
Here are actual, current estimates for fire, EMS, law enforcement, and emergency service entities in Indiana based on the latest reporting and official surveys:
EMS Provider Organizations
367 EMS provider organizations with distinct primary operating addresses are currently operating and certified in Indiana6.
These include:
Volunteer fire departments (EMS-certified): 34.1% (125 organizations)
Paid fire departments (EMS-certified): 19.5% (72 organizations)
Combination fire departments (EMS-certified): Remainder of total (exact number not specified, but majority falls within fire department categories)6.
Fire Departments (Total)
According to the National Fire Department Registry, there are approximately 800-900 registered fire departments in Indiana (2023 data, USFA/FEMA)1.
Of these, a significant percentage are also EMS providers, per above.
Police/Law Enforcement Agencies
Indiana has approximately 450 law enforcement agencies. This includes:
Indiana State Police
County sheriff offices (92 counties)
Numerous municipal police departments
University, airport, and specialty forces This figure is widely referenced in public safety datasets; exact current numbers may vary slightly.
Natural Disaster & Emergency Relief Services
32 organizations classified specifically as “Natural Disaster & Emergency Relief Services,” with a market size of $191.2 million in Indiana5.
Other Entities
National Guard: Indiana has an active National Guard contingent with approximately 65 armories and training sites statewide.
Federal Agencies: Multiple federal law enforcement and response entities (FBI, DEA, etc.) maintain offices and operational units in Indiana, though each only operates a small number of facilities or offices in the state.
TAM: Would encompass all organizations above (nearly 1,200–1,400 agencies/entities statewide, not counting private sector and specialty industrial response teams).
SAM: Those within realistic travel distance, relevant operational focus, or aligned training needs—likely a subset of several hundred.
SOM: The actual number of agencies/entities currently served or realistically projected to train at the facility annually—typically in the dozens to low hundreds, depending on class frequency, facility size, and outreach.
If you need even more specific breakdowns (e.g., number of paid vs. volunteer fire departments, EMS-only vs. dual fire/EMS agencies, etc.), those can be provided from source details16.
A former colleague of mine asked me to research a couple of items for him. The following is provided in response:
Perplexity Prompt: Consider this incentive: https://www.youtube.com/watch?v=hFC_CeYoImE. Provide data on how many agencies/entities by type of service (ie, fire, police, EMS, national guard, fed-dea, fbi, etc) might profit from its use. How might the facility best be funded from a non-traditional source?
Agencies That Might Benefit from the MAAC Facility
The MAAC Foundation provides no-cost, state-of-the-art training for first responders—including access at nights and weekends, equipment, tools, and consumables—to eliminate financial and logistical barriers to effective training1. A wide variety of public safety and emergency response agencies could profit from such a facility.
Fire departments: The 27,100 departments include career, combination, and volunteer; most are local, but a small share (4%) are state/federal or private fire brigades23.
Police: 17,985 policing agencies span local, county, state, and federal levels; about 15,400 are local law enforcement and sheriff’s offices45.
EMS: Over 18,200 EMS agencies respond to 911 calls; around 73,500 ground vehicles are in service67.
National Guard: 3,200+ facilities used for training, administration, and readiness8.
DEA: 241 domestic offices represent widespread federal law enforcement presence9.
FBI: 55 field offices, each overseeing local “resident agencies” for broad geographic coverage1011.
Profiting from Training Facilities
All these organizations require recurring, technical, and realistic field training. An open-access, well-equipped training center like MAAC could reduce costs, standardize training, enhance collaboration, and ensure readiness across agency types, from rural volunteer departments to federal teams.
Non-Traditional Funding Sources for Facilities
In addition to conventional government grants, alternatives exist to sustainably fund advanced training centers like the MAAC Foundation:
Alternative Funding Avenues
Private Philanthropy & Foundations
Grants from foundations dedicated to public safety, e.g., the Gary Sinise Foundation’s First Responders Outreach Program, which funds equipment and training needs for fire, EMS, and police agencies and prioritizes underfunded departments12.
Local businesses, regional corporations, and industries could sponsor training events, donate capital, or fund equipment in return for community goodwill and enhanced safety.
Specialty Grants
Foundations such as the Firehouse Subs Public Safety Foundation and others offer grants tailored to training, equipment, and facility upgrades12.
Training Rental or Membership Fees
While core training for responders could remain free, specialized or external organizational use (e.g., industrial emergency response teams, private security, school safety drills) could generate rental fees13.
Community or Auxiliary Fundraising
Events, naming rights, and volunteer auxiliary groups can support recurring operational costs.
Endowment or Legacy Giving
Long-term sustainability from investment income donated specifically for ongoing operating support.
Utilizing multiple non-traditional sources—especially those targeting public-private cooperation and mission-aligned philanthropy—can diversify support and ensure facility longevity beyond the limits of traditional public funding1312.
Summary Table: Potential Agency and Funding Sources
Agency Type
Entities/Facilities (U.S.)
Non-Traditional Funding Example
Fire Departments
27,100
Foundation grants, industry partners
Police Agencies
17,985
Corporate philanthropy, specialty endowments
EMS Agencies
18,200+
Public-private partnerships
National Guard
3,200+ facilities
Legacy gifts, rental for outside groups
Federal Agencies (DEA, FBI)
241 / 55
Joint training fees, corporate funding
Facilities like the MAAC Foundation are positioned to impact thousands of agencies across disciplines—and can tap an array of diverse, creative funding strategies to remain resilient and mission-focused intod into the future.
Last week, I had four health-related appointments. This week, I also have four days, Tuesday through Friday. I don’t know how I let myself get this crunched. As patients, we are at the mercy of faceless schedulers.
So here’s what’s coming up for me:
Tuesday at 1100. About an hour in-home meeting with a VA Caregiver program rep to inspect the readiness of our home for the program
Wednesday at 1330. Appointment with my heart doctor in Granbury, a routine checkup.
Thursday at 1130. Meeting in Ft Worth with the doctors looking into how to treat, if possible, the numbness in my legs that currently precludes my driving any distance. Last week, I had an MRA and two MRIs to provide input for this meeting.
Friday at 0920. Monthly meeting with my dialysis team. I assume the main topic will be how my IPN treatment is going, which is going well to this point, with the following exception: My weight, along with my appetite, has tapered off since starting the treatment. My last nine mornings’ weigh-ins are: 143.0,143.0,143.0,143.0,141.0,140.2,141.0,139.8,140.2.
Key Statistics
Average weight: 141.58 lbs
Median weight: 141.0 lbs
Mode weight: 143.0
Standard deviation: 1.32 lbs
You can easily ascertain from the bar graph above that in the last five days my weight has been falling off. This is with no change in the bags (all 1.5%) I’m using every night. The only change is the use of the 5-liter IPN bags.
