?? 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?