Curious:

When the first podiatrist felt he did as much as he could, he said to us "Alan needs to go to a wound treatment specialist". We checked his insurance and I called every wound care treatment facility in NYC. No one took his insurance.

The second podiatrist that Alan is now seeing is the equivalent of a wound care specialist. His previous podiatrist and I spoke and he said 'Oh, I know him, he's very good", "We've been to the same conferences and I know him".

And when I went with Alan on his first visit to this new podiatrist, he explained that his goal is to open a wound treatment center out of Methodist Hospital. This will be a goal that he will achieve eventually. So it's the best we could get under the circumstances. I figured, "a guy who is a podiatrist and specializes in foot ulcers and knows about regranex, and gave him the Cam Walker", well, he's the next best thing to an actual wound treatment center. And the fact that he's going to eventually be opening up a wound treatment center, well that told me he already had in play, all the ncessary tools that Alan would have gotten had he gone to the wound treatment center.....that is, regranex, Cam Walkers, etc. etc.

Alan did not receive this with his previous podiatrist (whom we both adore, and who is a pro and cutting toe nails and callouses and who did the bunionectomy on Alan's tailor bunion.

So Alan sees two podiatrists.

But because of his having neuropathy, one won't do it, and the second says "lets' do the orthotics", first.

So Alan is now going to call Dr. Hubbard (the ortho guy), make an appointment, (the guy has all of Alan's info already), and we shall see what this ortho guy says.

You see, I'm very thorough when I set my mind to doing something.

The stupid part of me should have by-passed all of this nonsense and gone straight for the ortho guy two years ago. I could bang myself over the head on that one. Thank God, Alan is not a diabetic. He heals just fine.

It's the position of the bone under his foot that has kept the ulcer from healing completely. We can only hope that the ortho will take a look, do the x-ray thing, and go, Aha!!! I can do this". One can only hope.

Oh, Alan is hesitant to ask the second podiatrist for the x-rays that he just took the other day, when he goes to the Ortho appointment. I told him. "that's being ridiculous. You simply have to ask. You are entitled to get a second, and a third opinion, I mean, you've been dealing with this foot ulcer thing for 2 and 1/2 years. Why wouldn't the second Podiatrist give you (or lend you ), the most recent x-rays."??

But do you think the ortho guy will order his own x-rays. I mean, X-rays are X-rays, right?? Or do ortho guys have a different standard of whatever they have to look at in an X-ray?. Maybe he just might need an MRI of the foot?

See, I have no idea what this ortho guy will order. I think it's just better that Alan brings any recent x-rays that he can bring with him, right??

Melody

here's what or what not be going on...Now I know the handsome dude,
Alan is your man i know it,so I don't have to take care of him..But anywho
you take great care of him...I know he's a tough guy so was my husband,
funny, a strong man. But my man had a heart attack sat down and said to
my Mom here you drive i'm sleepy... Well a few Drs. down the road told him
I believe you had a massive heartattack sometime in he past,as he points
at x-rays,I;m behind him shaking my head yes,and my husband is shaking
his head no. So I walk out with the Dr.honest he said men,put the prove
right in his face,no ,no ,no...Well go take a walk I 've got to make him
understand he might be feeling ok now, but he going to fall down one day
and well we got to do something now and not overthink it. My hubby
did'n want to listen to me,a rough old heart Dr. did the job.

Now no where has anyone say your stupid,I don't even understand that
word..My huband tough guy was afraid of surgery,darn I never knew
it..You all do what you gotta,and Mel I know you both keep that foot
clean,but no matter how clean,i've was a nurse in a hospital if his foot
get's a coming from that foot,good heavens Bob would of never
known skunk could of got him,never know..It's been 3 yrs.,do him a favor
in 3 weeks that Orth may pick a Wound Dr. if he said's he got to have
something grafted what ever,tell your man,I love you so do it..Bob was
afraid of me being left alone,well i told him no matter what mom said,i would
throw him out..They both got well didn't like it,but after the felt so good,
and i could smile again... You have done your very best.. Sue

every orthopedist that i have ever been too, or taken someone too has always ordered their own x rays. I think that it takes the variable out of different x ray machines having different quality. Just like every neurologist i have been too wants to do their own emg/ncs. It wouldnt hurt to bring the other x rays, he might want to compare.

he should use the x-ray already taken. if it doesn't show the view he needs...then i'm sure he will want his own.

i sent you a pm that i hope might give you some help. maybe give you some more oprions and questions to ask.

I agree c,most of the time they want to compare... to both Sue

sesamoids tend to MOVE so depending on when the last X-ray was done, he might need new ones. I think a surgeon would want the most recent view, if surgery is actually done.

How did he get this wound in the first place? If Alan has no feeling in his feet, he could not FEEL the pain from the sesamoid bone there?

I have sesamoid issues, and boy I certainly can feel them. I've had steroid shots in them, and use Salonpas when they are bad. Now they limit my shoe choices.
That is why I don't do treadmill any more, and instead do the less impact
ellipticals.

Aha, the $64 million dollar question. How did Alan get this foot ulcer??

Around two years ago, Alan wanted to go to the gym. Dr. Fred said "you have to get a stress test first, before I write you a note so you can go to the gym".

Alan gets the stress test, they find a blockage, Dr. Fred says "Alan you need an angiogram". During the angiogram, they do an angioplasty, and put in a stent.

A few weeks after that, he gets another stress test, all is fine, and Alan goes to Cardiac Rehab 3 times a week. Gets into good shape. THEN, he joins his gym.

What does he do??? go on the treadmill. Since he can't feel his feet, he didn't notice all the friction that a treadmill places on the foot.

Developed a bleeding ulcer, which got infected. He didn't feel a thing. We noticed the bleeding on the sock. Took him right to the podiatrist which diagnosed the foot ulcer, started the debridement, put him on antibiotics, and he would heal, then when he healed, he went back to the gym, and the same thing happend.

After a bunch of time elapses, x-rays are taken and the doctor says "oh, you have a bone inpingement (whatever doctor speak is).

So Alan had to stop going to the gym. Alan had to try oft-loading shoes, they would change the orthotics, but all during these conversations, the question I would ask is "Can't you guys do anything surgically, to fix this situation?" and the answer would be "no, not with his neuropathy", there are complications.

I then said "but you did an operation on him before, you took off his tailor bunion, he kept off his foot for 6 weeks, he was fine".

I was told "but this is different, there is a bone underneath which is impinging, blah blah blah.

At that point, Melody should have realized that podiatrists are not medical specialists and I should have looked up Ortho guys.

Hey, better late than never.

Today, when Alan comes home from Dr. Fred, he'll be calling the Ortho guy.

Right now, I have to call the IVIG people to confirm his delivery of the gamma next week.

Never stops!!

lol
Melody

-------------------------------------------------------------
UPDATE.!!!!!!!!!!!!!!!!!!!!!

Phoned up Dr. Hubbard. Alan has an 8 a.m. appointment on December 18th.
And the girl said we didn't have to bring any x-rays, they do their own x-raying. And because I never spoke to this person before, and because Alan hadn't kept his appointment, all the information that I gave the girl last month, was of course, not in their system any more, and the first question was "how long has he had the ulcer and is he a diabetic??".

I explained the whole thing. And since we have recent copies of x-rays, and he just got his blood test results today, we'll bring them too. Can't hurt.

Oh, he says "they took an EKG and it was abnormal". I said 'what did it say and he says: "well, I asked Dr. Fred and he says not to worry about it". I told Alan, "On the top of the report it either says Tachycardia or Bradycardia or Normal. What do you remember?? (I knew this because I've examined every single ekg I ever took and I remembered that there is a result at the top of the page).

So Alan said "Oh, I remember, it started with a BR, so I said 'okay, this mean you have a slow resting heartbeat". He said "Well, Dr. Fred said, I'm just fine". Maybe it's the blood pressure meds he's on?. He felt fine by the way. His blood pressure was 98/70. I told him. Cornell Medical Center loves when your blood pressure is that reading. So, so far, so good.

We shall see what the ortho guy says!!!

Alan thinks he's getting operated on the next day. I just looked at him.
oh my god!!! lol

Having a low blood pressure is not necessarily a good thing. Autonomic neuropathy can cause both low blood pressure and bradycardia, which together is a very not good thing. (I have it, I know.)

I think going to the ortho is a good thing, as long as ortho is in touch with neuro and they are on the same page.

Podiatrists are classifed as medical professionals, as are chiropractors.....Chiros don't prescribe meds, as far as I know (to date-this changes and may be by state)...I think podiatry does.

It is getting to be a very gray area as to whom is what.

I have 4 years into a nursing education, (plus grad credits) yet a physician's assistant who takes very similar courses at the same university, comes out and can under a doc prescribe a med....me, I have to put $30K more into a masters to be a nurse practitioner to get the same privilege...go figure (I am too old and sick to put that kind of cash into any career at this point).

The credentialling is a political issue. It is called lobbying. Nurses got outlobbied.

I tell you all...and to all I proclaim....if the name tag does not clearly ellucidate the credentials....don't believe who is a doc or nurse any more. I know physician's assistants that are called doctors, medical assistants who are called nurses, and nurses who have both 2, 3 and 4 years of education. Advanced practice RNs will always be nurse practitioners or clinical nurse specialists and their credentials will usually say, MSN....RNs will either have Associate, Diploma or Bachelor's degree, all those say RN, and if 4 year will say BSN. LPN or LVN will say either and they are one year programs.....by the way....just about any one can stick a needle in you these days....doesn't take any license to do that anymore. In general...most places still require an RN to put in an IV....except that radiology techs can now do it for tests....see what I mean about gray areas.....

That said, I know some smarter less credentialled people I would trust over some more credentialled dumb people. I once met a flight nurse....an RN who flies in a copter to accident scenes and the guy also works in the ER...he didn't know what PTSD was...duh.

Whadda ya do?

is called bradycardia.

Beta blockers like Lopressor can cause this. I seem to recall that Alan takes
Lopressor (metaprolol)?

Yup, I know all about the Brady thing. That's why I asked Alan, what did it say on the top of the report?? When he said BR, I said "okay, that's bradycardia, you are on blood pressure stuff because of your stent. He's been on metoprolol (25 once a day) ever since he got the stent. Initially they put him metoprolol and altace, but over time, they discontinued the Altace. So now he just takes the metoprolol and the plavix and a baby aspirin, (as well as his supplements).

Oh, I found out lots of info while I go to Cornell Medical Center. Besides being in their diabetes protocol, I'm in their blood pressure program, (the intensive protocol is what they call it), they have all new criteria in determining the numbers.

What used to be satisfactory was 120/70. Not at Cornell. Not if you are a diabetic.

When I go there and my pressure is 98 or 100/68 or over 65, they all go crazy, they are so happy. I had no clue. And the head guy said "we have new statistics that we go by now. Even the numbers for blood sugar have changed.

So Alan isn't dizzy, and his primary care guy and (he'll have to call the neuro), but when we see the ortho, thank god, this Ortho guy is an orthopedic surgeon who has a great deal of experience with people with neuropathy. That was one of the first things I checked when I phoned them some months ago.

I really don't think we can do anything else at this stage of the game.

We'll keep the appointment on the 18th. (he gets the IVIG on the 4th), and hopefully on the 18th, we'll be told, "yeah, I can help this guy, LET'S BLAST THIS ULCER AND SEND IT ON IT'S WAY!!!!"

One can only hope.

Melody