?? re Sepia Bone in Alan's Foot
 

Hi All:

Alan just came home from the podiatrist. As you all know, he's had this recurring foot ulcer for over 2 years and all the orthotics, regranex, bandaging, oft-loading, well, didn't do the trick.

Alan was to go and say "Listen, enough is enough, I want this thing shaved down, I can't live like this, I can't go anywhere or do anything and this is no way to live, if there's a chance, shave this thing down". (During his last podiatrist visit two weeks ago, his doc said "wait until the orthotics (newly re-changed), wait until they come in and if they don't work I'LL DO THE OPERATION.

This was two weeks ago.

Well, the orthotics came in yesterday (at the other podiatrist, who has been Alan's podiatrist for over 10 years, and who sent out the orthotics to be re-furbished ....with a written prescription from Alan's newest podiatrist), So Alan's regular podiatrist (who does the nails and feet and has tried to heal the foot ulcer), well nothing worked, so Alan got the second opinion from the second podiatrist.

So Alan goes yesterday to the regular podiatrist (the first podiatrist), who said "you're newly refurbished orthotics are here, let's take a look at how your ulcer is doing".

Seems it is not healing. The podiatrist said 'you need an operation, you really have no choice, I don't see these or any orthotics really doing the trick" Alan said "would you operate on me if you could", and he honestly said "no, not with your neuropathy, too many things can go wrong".

So Alan came home yesterday with the new orthotics and went TODAY, to the second Podiatrist who he has been seeing for 5 months. Alan said 'Okay, no more, nothing is working, I really need an operation".

So the second Podiatrist (who also specializes in wound treatment, and that's why we chose him), said this to Alan

"No, I'm not operating right away. I don't do things in that order. I have to do these things in steps. First we do the orthotics. (He gave him regranex, and we are again doing the regranex in the a.m. and me wrapping up his foot every morning).

He then said "you have to wear the shoes (with the orthotics in the house, and when you go outside, wear the Cam Walker). He's going back to the doctor in ten days. The doctor will then say "oh, it's all healed, you don't have to wear the cam walker outside.... I really don't know what else he might say.

Oh, Alan brought the orthotic (there's only one that had been re-furbished, his right orthotic because that's where the ulcer is...on his right foot), so he brought the right orthotic to the podiatrist today, and the doctor took this particular orthotic and built it up even more saying: 'this needs to really be built up so you don't have any pressure on the area of the ulcer". So now Alan's orthotic has this padding underneath (with a cut out area where his ulcer will just be). Actually, you might even call it an oft-loading orthotic because that's exactly what it's doing.

So I'm thinking "what does Alan now do?? Does he wait YET ANOTHER 10 DAYS (after doing this for over 2 years). Or does he call up the Orthopedic Surgeon and make an appointment.

Today, the podiatrist took 2 x-rays. He told Alan "I know exactly what has to be done. It's the sepia bone (correct spelling of Sepia????) I tried to look up Sepia bone on google but it only refers to animals and I can't find anything with Sepia bones underneath a person's foot.

Alan's doctor said today, "there is a risk of infection if you have surgery, there's a risk your neuropathy pain will get more intense, etc.etc.

Now, a few months ago, we found a Dr. Hubbard, who is an orthopedic surgeon who works with people with neuropathy who have foot ulcers. I spoke to his office, and they assured me that they know all about neuropathy, and foot ulcers, etc. We made the appointment, then Alan changed his mind and said "let's wait until we see if the orthotics, and the cam walker works. It's been about 2 months since then.

I do not know why Alan has not immediately phoned this orthopedic surgeon and gone for a consult. He's a grown man and seems to depend on me to make decisions. He asked me "what should I do?"

And I know I have asked you guys this before but honestly, he really has no option here. He needs to have this particular sepia bone shaved down and perhaps another bone re-positioned. Alan also asked the doc he saw today, if he can do this operation and the doc said "sure but there are always complications and in your case, you have neuropathy".

I said "you should have kept the appointment two months ago, with the Orthopedic Surgeon, but you cancelled, this is not for me to decide"

He's very confused and really doesn't know what he can do. I told him "If I were you, I'd go with a guy who specializes in treating people with foot ulcers and neuropathy. At least go for a consult"

He wants to wait the 10 days and then make a decision.

And what the heck is a sepia bone??

Thanks for all your suggestion.

Melody

sesamoid?
 

There are two sesamoid bones in the ball of the foot.

I don't know what sepia is. never heard that term before.Sepia is a color/dye.

here is a quote on sesamoids:
from http://www.coa-aco.org/library/clini...and_ankle.html

One thing you need to clear up with foot doctor. Alan's problems are NOT diabetic. Diabetic's would be high risk for foot surgery...but he is not.
Some doctors (and podiatrists are fringy doctors at that) equate in their minds neuropathy=diabetes.

I think you need an MD here like I suggested before.

If it were me, I would get the opinion of an MD, too -- the orthopedist. I know it is frustrating for both you and Alan, and it is tough to wait on yet another opinion, but I think haveg an MD weigh in would be a great idea. They do have a more extended education.

Mrs.

I'm laughing my *** off. I just read your response to my post, and the first thing that popped out of Alan's mouth is "What language is she talking??""

And when I mentioned sesamoid insted of sepia, Alan said "That's the word". I said 'But you said Sepia Bone". Alan said 'what's the difference".

Oh, all of Alan's docs know that he is NOT diabetic. They know all about the CIDP and IVIG .

And all of his doctors are medical doctors. My question was, does he go to his podiatrist (who has done this on other patients), or does he go to the Orthopedic Surgeon who specializes in Neuropathy??

My vote is The Ortho guy. I mean, doesn't this make sense.

Oh, and the ortho guy already has his whole background from when I emailed that office over 2 months ago. Everybody knows Alan is not a diabetic.

It's the stupid sesamoid bone in his foot that's out of alignment or something. It's the bone closest to the big toe on his right foot.

Mrs. D, when Alan said "what language is she speaking, I just about fell off the chair!!!! lol

Melody

I totally agree with Mrs. D. especially when it comes to Podiatrisrs,
Mel read it again,it 't not funny in any language...If it's not healing
it shoud have some skin grafting...It took Bob 6 weeks to heal,but
it's fianally healed. And no more trouble,no more pain,or blood or
infection. Hugs Sue

Well now, I must be the most stupidest person on these boards. I thought a podiatrist was a medical doctor. I do know that the ortho is a better specialist (in the bone department). That much I knew. I especially appreciated the fact that this Dr. Hubbard is extremely knowledgable about people with PN.

So I will tell Alan exactly what you guys have written.

He just walked over to me and said "You know, I think these orthotics are working, my foot feels better"

It was debrided today also.

So we shall do the regranex and wrapping thing for the next ten days and then he goes back. If all does not continue in a positive vein, I do hope he goes and sees Dr. Hubbard. God, almost 3 years now and he still has this ulcer.

I don't know why no one told us to see an ortho guy two years ago. Don't these doctors refer you to specialists when they know they can't do any more??? I must be clueless.

thanks much

Podiatrist
 

Hi Melody:

I have always thought of podiatrists as "foot doctors" and had the impression they weren't "real doctors" with traditional medical degrees, but never really confirmed my thinking.
Just looked it up on Google, and they have a DPM, which stands for Doctor of Podiatric Medicine. So now we both know!

Alan has had that ulcer for much too long and I hope you can get to an orthopedic doctor and get this cleared up once and for all.

Shirley H.

Shirley:

Alan says he's calling Dr. Hubbard today.

We shall see.

Thanks to you and everyone for setting me straight. I knew about the Doctor of Podiatric Medicine. But I thought that meant he was a medical doctor.

jeez.

DPM training:
 

Contrast with MD training:
The podiatrist has 2 yr pre-training 2 yr podiatry training =4
Medical training =6 to 8 yrs

Podiatrist for surgery 1-3 yrs after the 4
Medical 3-8 yrs for surgery or other speciality after the 8

I think it is a significant difference in training.

melody, has alan been to a wound care clinic?

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 :eek::eek: 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...:D:D:D You have done your very best..:hug: 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.

:hug:

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

the little
 

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?

slow heart beat...
 

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

Mel
 

We blasted Bob's time for Alan,than rest sugar..Or make some more
cute video's,heaven knows that was fun,but warn Billye,and me ,want
my pillow under my behind...Bless you both Sue