Need some in re: Alan's foot ulcer
 

Hi all.

to sum up, he has a recurring foot ulcer for YEARS. The doctor will debride it, it will then form a callus, the doctor will debride it again, etc. etc. It always used to heal.

He's not a diabetic, never was. Idiopathic.

He got the ulcer because after his stent, they sent him to cardiac rehab, he went on a treadmill, and got a foot ulcer. It ALWAYS used to heal.

Well, for whatever reason, this time it's not healing. His podiatrist has explained to us that he has some kind of bone impingement under the ulcer so that when he steps on it, it will come through and that's why he bleeds. He also explained that in other cases, they would shave down the bone and the ulcer would then heal and that would be that.

But because of Alan's neuropathy, he says (and he also says that they have discussions on Alan all the time because of the severity of his neuropathy), well, when I say "you can't operate, you can't do ANYTHING?'

He would respond. "We don't operate on Alan, if we operated the bones supporting each other (underneath where the ulcer is), well they might collapse so we don't operate on Alan'

I understand this. He's been our podiatrist for over 15 years. He operated on Alan's bunions and takes good care of him.

I then asked the doctor (this was about a month ago when his foot would not stop bleeding everytime he walked on it).

I said "we have a wheelchair in the house, why can't he sit in the wheelchair and wheel himself across the rooms, and do this until the ulcer heals, can't he do that??"

He responded "he needs to walk" I would gather he's afraid of blood clots or something??"

Alan also tried the crow boot last week when we had to go out. It hurt him on the front so he won't put it on.

He wears custom molded shoes. With a well dug out under the foot ulcer. I gather this is no longer doing the trick for him.

He sees the podiatrist on Tuesday to check on how is ulcer is doing and if it needs more debridement.

So what has been happening is that the little hole does not close and if he walks, it bleeds. Even if he walks to the bathroom.

I'm not talking gusher here, but still, he has an open wound. I watch it carefully, dressing it, (following the doctor's instructions) and he always says to me "Melody I'm never worried because you know how to take care of that foot".

And we have an appointment with the vascular guy on Friday. Alan has a bit of edema going on, (the water pill does help). His primary care doctor, Dr. Fred referred us to his buddy, the vascular guy and he explained to me "He's also a wound care specialist"

I said "Oh maybe he'll put Alan in one of those oxygen tanks" and he said "yeah, might be"

So we ARE on top of this, AT LEAST I AM, and if any of you have dealt with foot ulcers that eventually do not heal, and what you did about that, I'd appreciate hearing from you.

Also, what happens during the first visit to a vascular wound specialist. Do they put dressings, ointments, do they put you in oxygen chambers??

We have no clue.

And what can we do about his bleeding every time he gets up and walks anywhere. I mean, there is always blood on his socks. I make him change them all the time. And I use bacitracin. So far, and he's been going every two weeks to the podiatrist, so far, no signs of infection, thank goodness for that.

When I asked Alan, "but your ulcer always healed before?" he said "yeah, but this time the hole is bit bigger". He's right, the previous times it was a pinprick. This time it's a little hole (where the doctor debrided it).

I hope the wound care guy will do SOMETHING!!!

Thanks for any input
Melody

Well, I would be putting a dressing on that all the time.

Change it daily. Something cushiony --let the podiatrist recommend something.

Zinc is a great healer... perhaps Alan needs some oral zinc?
This is given typically to people with bedsores and other hard to heal wounds. You have that zinc at home anyway still?

Also l-arginine helps too. In nursing homes there is a drink called ArginAid but you can give Alan tablets...same thing. This heals skin wounds/ulcers. Vit C. Also.

If you go to a wound center they have special dressings that you leave on for days... and are designed to help the wound build a matrix of tissue for healing. They are very expensive, so see what would be needed, and call your insurance to see if they pay for it. Since Alan is not diabetic there may be resistance for them.

I would not let this wound be leaking into socks. I would be putting a sterile pad on it. Some wound healing products have silver in them. But since Alan is allergic to sulfa, the typical silver sulfadiazine cream cannot be used.

I think he will need to go to a wound clinic. These are more common now, and very useful. It is a miracle he hasn't had a severe infection yet IMO.

Hi. THANKS MUCH

I do have the Optizinc that I take, I'll give it to him 3 times a week starting tonight.

And about why he hasn't had an infection yet. THAT'S BECAUSE HE HAS ME!!!!

Even his doctor says this.

I never in all my days thought that besides his not being allowed to get special shoes because he's not a diabetic, that they wouldn't pay for special dressings??? Oh my god.

Never even thought of that.

We shall find out on Friday. I will update.

Oh, I have a question.

I have Silver biotics in the house.

Might I take some drops of that, place in water, and then take a q tip and put on his wound. At least as a start?

What do you think?

Thanks much

Melody
P.S. I just asked him to please use the wheelchair in the house, just to go form one room to another. He said "not until the doctor says so".

My goodness, he is so stubborn.

Mel

Well, I wish I could say, it would work... but I really don't know
Mel.

So it is your decision to use the silver that way.

Well, it can't hurt, so I'm going for it.

Will update AND THANKS MUCH.

Melody

P.S. Just did it. Put a drop on his ulcer. Put a bandage over it and then the sock. He's lying down on the couch with his leg up.

Will continue this tomorrow. Hey, can't hurt, might even help. Reminds me when I told one of his doctors that I use Methyl B-12 for my neuropathy and it went away and the doctor pooh poohed me and said "I would NEVER use B-12 for anything other than anemia".

And sometime later, this same doctor came down with neuropathy, and asked me "Tell me about Methyl B-12 again". See, doctors are smart and they know stuff but sometimes we have to experiment and use non-medical interventions. That's what I'm doing now with the Silver biotics. And I am diabetic and haven't had a UTI for over 15 years. you gotta love that silver!!! lol

you have to be stubborn to live this long.

since the wound hasnt healed basically in years i dont think that it should be an insurance problem to get a special dressing at this point if it is coded properly.

things get complicated when you have one thing that affects something else and then cant be treated without more complications.

i just found a pretty nasty looking crack wound on the bottom ball of my fight foot which of course i hadnt felt. this winter has been a killer. its taking a while to heal.

too bad Alan is allergic to sulfa, silvadene is very effective for healing and preventing infections. i have a big tub of it from my past life that i use when needed.

make sure that whatever dressing you are putting on the wound does not "fill in" the space that was left in the shoe to "off load" pressure from that spot.
Think "princess and the pea". Has Alan ever had a 5 hour GTT? Just because he wasn't diabetic last year, doesn't mean he can't be this year.
Good luck

They have given him various diabetic tests. He just got blood tests results back two days ago. His fasting blood sugar is 80. It NEVER goes above that.

We even filled him with sugar once (to see if it could register above 120). It went to 100.

So no, he's not a diabetic.

I hope whatever dressing they use, works, and that's it covered because his insurance WOULD NOT COVER CUSTOM SHOES OR OTHOTICS.

Nasty people these insurance people.

And I am very careful to not have the dressing that I put on, fill in the hole in his foot. Very careful.

Thanks much

Melody

Do they do an A1C on Alan? That would show much more than a fasting glucose.

He has had numerous glucose tolerance tests. He gets a blood test every 3 months (for years). His sugar has NEVER gone over 80. And I just checked the test and his a1c is 5.7.

How could this man be a diabetic? And we truly believe his neuropathy stems from his back. Even his neurologist is sending his mri results to a back specialist. She saw something on the mri and someone once told him "your back is really screwed up and if you have an operation it's going to be a big one"

They could never in the past associate his neuropathy with his back, but now that he is 63, his back is so bad I have to massage him 2 times a day (especially if his neuropathy is going nuts), and when I pound on his back and massage his spine, the pain in his feet goes away).

To me, this smells of a back issue. He has another appointment with his neurologist soon. He couldn't make the last one because of the snow around the end of December.

He can't walk long distances because of his back. To me, that tells the tale.

They might not have seen anything on previous MRIs but this last one (so they say) was a doozy.

He has degeneration and spinal this and spinal that. Too many things on that paper. He will go over everything at the next appointment and I'll post here and tell you what his neuro says.

Yesterday he was taking a nap on the bed and he was moaning, Oh my feet are killing me". I went over, starting massaging his spine and doing what I do and he immediately fell asleep.

It that is not a back connection, I dont' know what is.

Melody

Mel, you could try a product called DuoDerm or Replicare. Something similar I have been able to find at Wal-Mart is a band aide product used to cover blisters. They are a "hydrcolliod" dressing that is made to stay on for a minimum of three days. When I was working HomeCare I would clean the wound GENTLY with soap and water, rinse well with normal saline (to make your own boil water and add 1 tsp salt to 1 quart boiled water, can seal in Mason jar or keep in ref for 1 week no longer) then if you wanted to apply a drop of the silver let air dry and apply the dressing. I would use a Metaplex tape ONLY if needed to keep in place for three days. Another product is Spenco "Second Skin" it is a saline based gel that is changed daily, more of a cushion. Like Mrs D said, I would not leave it openwhen he is up on it, too much risk for infection. Along withe the zinc and C I would increase his protien intake (unless he is experiancing renal failure). A wound consult would help with insurance.
Good Luck!
pooh

Have you ever tried honey on his ulcers? I don't mean local store-type honey, but pure honey from bee farms. Pure honey forms a crust when applied to the ulcer, and it's a treatment I successfully used for many years as an RN in a hospital setting.

Correct me if I'm wrong, but I seem to remember that Alan has diabetes...... and if so, I don't know what locally applied honey would do to his blood sugars, but I'm sure there are others here who could help with that.

Something else outside the box?

Homeopathic "remedies" or "cures"??

all the blood tests and MD stuff hasn't fixed it yet...:rolleyes:

http://www.webhomeopath.com/
http://www.abchomeopathy.com/
http://hpathy.com/abc-homeopathy/hom...-for-patients/

Have you looked into using a knee walker instead of a wheelchair to keep him off that foot? Here's what they look like. You may be able to get a used one at better price. Don't know if insurance covers these but a few of my friends who have injured their ankles used them during recover to get around.

Here's what they look like:

http://www.amazon.com/Roll-A-Bout-Al...m/B001LJASQ0/2

I think I recommended a knee type walker once long ago.
I met a doctor at a conference who had one.

You know, I wonder....why is that podiatrist debriding a callus?

Have you seen another foot doctor and determined that this treatment of removing skin, is necessary? Or could it be actually prolonging healing?

is this an upward trend in the A1c? this is the high end, the very end, of what is now considered normal.
when you are massaging the back is it down into the butt? I am thinking piriformis....though that is really deep and i am not sure you could do much for it....just thinking out loud.... could have more than one thing going on.

Alan has NEVER had diabetes in his life. I am the one in the family with diabetes (under control thank god for that).

Alan has idiopathic PN (which they now are certain is linked to his back problems).

I have never heard of so much information about dressings, second skin.

CAN'T THANK YOU GUYS ENOUGH.

Going to print all this out and bring to podiatrist today.

THANKS THANKS THANKS.

What would I ever do without you guys??

Love ya
melody

Re: Knee walkers. We saw that a long time ago when he went to a previous podiatrist. Alan said "this is not for me".

One of you said:

"Is this an upward trend in the A1c? this is the high end, the very end, of what is now considered normal. When you are massaging the back is it down into the butt? I am thinking piriformis....though that is really deep and i am not sure you could do much for it....just thinking out loud.... could have more than one thing going on. "

Don't know anything about upward trend in the a1c but alan has had numerous 6 hour glucose tolerance tests over the years (remember he has had neuropathy for over 20 years). In the beginning his fasting sugars were in the 75 to 85 range.

He has NEVER gone over 80 or 85. Never. Only when we loaded him up with sugar one night (the night before another blood test), we wanted to see what would happen when the doctor took the blood the next day. And believe me, we loaded him up with cakes, cookies, pies, orange juice, whatever. Even the next morning (before the blood test), he drank orange juice and ate some cake after breakfast.

His sugar was about 90. So honestly, at this point, I don't see any diabetes connection.

Maybe someday in the future (if he doesn't lose any weight), but not now.

Now about the back massage.

I massage towards the buttocks. That how he gets relief. I treat it like I would treat sciatica. Down down down. He loves it.

When I massage his shoulders and upper spine, he just loves it because it feels good (has nothing to do with neuropathy).

But when I do the lower spine and massage the glutes and go down his body and especially when I carefully massage the legs (I know about clots and I showed his former chiro what I do and he said "you're good", well that's when he sighs and says "Oh my god, all my neuropathy pain is gone".

And last week Dr. Fred checked his circulation and found EXCELLENT BLOOD FLOW.

So when we come home from podiatrist today, I'll update you all

Melody

P.S. Mrs. D, you ask why the doctor debrides the callouses. That's because Alan makes callouses around the ulcer and that's when it hurts him when he walks. As soon as his podiatrist does his feet, he says "I feel like a new man"

What happens if he goes in socks or bare foot for a day or 2 staying off the foot most of the time, does it get any good healing done in that time frame?

With the sore spot bandaged/dressed of course, but no shoes or slippers..
Maybe the shoes or slippers aren't fitting well and causing continuous irritations/rubbing??
also holding in excess moisture too, maybe some fresh air and even sunlight might help it.

:Oops: Sorry Mel.

I knew one of you had diabetes :o

This is another product I've had success with when it comes to healing ulcers. Easy to use, and easily obtainable.

Hi everybody.

We went to the podiatrist today. What an interesting afternoon. He took a look at Alan's ulcer and said "Actually it's not that bad, look at the tissues around it." I said "is it infected"? He said "Well, actually, when we see an open wound we consider it an infection, but I know what you mean, and no, it looks good, I'm going to debride it, we'll talk about it, and he does not need an antibiotic".

He then debrided it, asking me to come around by his chair and look what he was doing. He said "look at how pink every thing is, he has good (and I can't remember the word he used, but he liked the look" lol

I then said "someone asked me why you cut off the dead skin around the ulcer".? He replied "because no new skin can grow over dead skin"

Then he said "I'm going to prescribe two things for him. The first is a Sodium Chloride solution (he told me how to do it),

The second was SANTYL, which is a Collagenase ointment. He explained exactly what I was to do.

So once a day, I'll be cleaning and dressing his foot with these items.

He said "I know he's in good hands"

I then asked him "why on earth can't he stay in the wheelchair when he is in the house, wouldn't the ulcer heal faster?" He said "I know you, and if you put him in a wheelchair, you won't let him out'. I promised the doctor, then when he goes outside, he'll be able to walk, but when he is in the house, can he please use the wheelchair?" The doctor said "fine", so I won that round.

I then told him we would be going to see the vascular guy on Friday and did he think he might put him in an oxygen chamber. He said "actually I don't think so", and he explained that Alan's foot ulcer is a pressure wound, caused by the bone impinging on the bottom of his foot.

I asked him if the vascular guy might put the dressings on it, (the ones that form a matrix). He said 'I really don't think so, but then again, I'm not that doctor, but those dressings are used for diabetic foot ulcers (that are caused by different circumstances that Alan has"

I then asked him "and you can't shave down the bone that is causing all this WHY???"

He explained: "Well, in Alan's case, we can't go through the bottom because it's been my practice that when you go through the bottom, the scar is so painful that people can't walk on it". I then said "but he doesn't feel anything, he has neuropathy"

The doctor turned to Alan and said "And you don't think you might ever get feeling in your feet".? Alan said "I've had this for 20 years, what do you think".

I then said "We think it's from his back, and he said "Of the people I know with neuropathy, the majority of them have it due to back problems"

He said "I myself would never operate on his foot". I said "do you think we will ever find a surgeon"? He said "well, you never know, keep searching, but actually what Alan needs IS NEW INSERTS. That will do the trick.

He took Alan's insert out of his custom shoe, and held it up and said "look at these, these are all worn out, he needs a new insert in his right shoe, it will make all the difference"

Because we know that insurance won't cover this, I guess that tomorrow, we'll be calling up Orthotic people and try and get a quote.

We'll do this. It will just take time.

So there you have it.

In the podiatrist's opinion, Alan needs a new insert in the right shoe.

So onward and upward!!!

Will update after Friday

Melody

http://www.sacrowedgy.com/piriformis...Fcnc4AodsyY1HQ
http://aolsearcht9.search.aol.com/ao...e?q=piriformis syndrome&v_t=keyword_rollover

glad you got some answers good luck:hug:z

Hi. I think he's debriding the ulcer, and the callus that forms around it, well when Alan steps on it, it hurts him, and when he walks out of the podiatrist's office, he always says "Ah"!!!!!

Tonight I checked his sock and it was bloody. His doctor had prepared me for this. I told Alan "let's clean you up and I'll put a new dressing on it".

I took off everything (oh, I remembered what the doctor said when he asked me to sit next to him and he showed me Alan's foot, he said "good granulation, wow, look at that". So whatever good granulation is, Alan's is good.

After I cleaned him up, I used the saline wash, took off the dried blood, I took a q-tip and put a dab of the Santyl in the wound, covered with a non stick gauze, then another gauze, and then I wrapped the covering bandage around it. He is good to go. I read up on this Santyl. It has had good results in people with pressure ulcers.

I would have made a good nurse.

lol

Melody
P.S. Do you know that when I came home, I cooked dinner, served him, cleaned my kitchen, dressed his bandages, AND THEN I DID MY SPROUTS!!!

Thank goodness I drink wheatgrass juice. lol