Leg Wounds

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latata

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Hello, I am a child of a parent who has diabetes, type 2. He has had a wound on his leg since August and it is not healing. He does go to the doctor, but he really doesn't want to and says they are stealing the time he could spend working. Any ideas on how I could motivate him to go and not avoid the visits?
Also, the skin around the wound is red and hot to the touch - it is probably worth mentioning that both of his legs are dark red on the area above his ankles, around 10cm, and only the area around the would he also has around 10cm above his ankle is hot to the touch. Could it be infected? Do any of you have a similar wound? My mom places a fresh gauze on it every evening and we try to be as sterile as possible. I really do not want him to lose his leg or for the infection to get to the bone.

I would really appreciate any answers or advice!
 
Is he aware of your fears? You can't actually force him to pay more attention to himself BUT if he does lose a limb, who is he expecting to look after him? and is that expectation fair on them? Or indeed the worry, on you?
 
Red and hot to the touch sounds like it could be infected. Has he taken antibiotics for it? Is the wound being dressed by a nurse too? How’s his blood sugar? Controlling blood sugar will help.

Tell him he’s doing it for your sake not just his own. Maybe then he’ll think the visits are less of a waste of time.
 
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I lost my leg to diabetes after over 50 years of Type I. The effect on your life is devastating! I had to move from my forever home, get rid of my car, can't just go for a coffee with friends (and that's the ones who haven't walked away as it is too much bother). And then there is the phantom pain although not all amputees suffer this. I have met people who lost a leg after only 10 years of Type II. He has to take this seriously for everybody's sake. Once serious infection sets in it can turn to sepsis very quickly!

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Hi @latata

Please ask him to seek medical help for the wound as a priority. A hot red wound with discoloured skin that hasn’t healed since August needs medical attention as soon as possible.

Open wounds & diabetes can go very wrong very quickly. Infection causes higher blood sugar which in turn feeds any infection.

Tell him how worried you about him.
 
Wounds that don't heal quickly do need expert attention as the nurse at the surgery will probably have access to special dressings that you can't buy over the counter but it also may need a course of antibiotics to help the healing process.
Getting the right treatment is important.
Sending a picture to the GP can help them know if further attention is needed and with whom, likely easier to get an appointment with the nurse than the GP.
Consider that time to getting it attended to well spent if it saves the leg.
 
I have been documenting my foot/leg issues here as it has been going a long time: https://forum.diabetes.org.uk/boards/threads/my-poorly-leg.106990/

The sooner your father seeks advice the sooner the problem will be sorted and the higher the chances of a positive outcome. I have only encountered two bilateral amputees. One was in the amputee ward and I never got to speak with him as he was crying constantly - it was in lockdown and I am sure he was suffering mental health issues and not getting the help he needed. The other was at amputee physiotherapy where they were learning to walk on their stumps.
 
Sounds like being in denial and thinking it will be OK I done that last Christmas and 7th Jan after having daily trips to hospital for iv antibiotics I had emergency surgery on my foot and removal of nearly half my foot and now suffering from charcot foot 11 months on.

Needs to get his sugars in range does he have bad eating habits and needs to see docter to get treatment and plan in place or things easily get worse and to bone as I found out.
 
There was a great opinion piece by a vascular surgeon in the NY Times yesterday: https://www.nytimes.com/2023/11/27/opinion/peripheral-artery-disease.html

In the fall of 2021, a soft-spoken woman in her 60s came to the emergency room where I worked, complaining of pain in her foot. When I examined her, I could see that I would need to amputate the infected leg immediately, or she risked sepsis and death. I amputated her leg that night. She died 14 months later.

The entire episode could probably have been prevented. My patient was one of the estimated eight million to 12 million Americans with a condition called peripheral artery disease, in which clogged arteries limit the flow of blood to the legs, damaging and eventually killing the tissue. While the disease can’t be cured, it can often be managed with routine monitoring and lifestyle changes like exercising, quitting smoking and taking blood-thinning and cholesterol-reducing medication. If the disease worsens, more aggressive treatments can help unblock or bypass blood vessels to increase blood flow to the foot. Amputation should always be a last resort.

But this wasn’t my patient’s experience. Peripheral artery disease is more common among Black Americans, like my patient, in part because they are less likely to be effectively treated for its predisposing conditions like diabetes and hypertension. Many, like my patient, don’t seek treatment until they have a wound that won’t heal, the last stage before an amputation. This is largely because of a lack of access to health care and also because there is no gold-standard treatment for people with the disease.

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While general guidelines exist for treating peripheral artery disease, there are few incentives or penalties for not adhering to them. As a result, care is at the discretion of the doctor, who may not be well versed in limb salvage care or have the resources to perform limb-saving procedures. A lack of oversight and standardization in treatment has led to too many unnecessary and inappropriate procedures.

Medicine needs a standard for treating advanced peripheral artery disease and an incentive structure to enforce it so that hospitals and doctors amputate only as a last resort. To do that, we need large, government-funded population studies of peripheral artery disease patients. This will help vascular experts determine what the average amputation rate should be for patients with certain disease patterns and characteristics.

This isn’t a new idea. In 1971, President Richard Nixon initiated a campaign against cancer that led to the creation of accredited treatment centers and research that helped establish national care standards. Nowadays, a patient with a cancerous tumor is treated according to clinical practice guidelines.

Cancer centers that provide care are regulated by the government or accreditation bodies to ensure they are providing an acceptable standard of care. The idea is that wherever a patient may go, the care pathway should be the same for every patient regardless of race. It is not a perfect system, and racial disparities remain, but it has helped narrow major gaps in care. Policymakers and hospitals could take some of those same lessons in collecting data on peripheral artery disease and apply them to creating a standardized approach to care and centers to treat patients.

When I told my patient that we’d have to amputate her leg, she asked me what she could have done differently. I told her that perhaps if she had come to me sooner, I could have adjusted her medications and fixed her leg blood supply so her wounds would not have become infected. But the underlying problem is that the health care system is not providing equitable treatment to this population.

My patient did not have to die the way she did. We should work together to create a gold standard of care to treat patients with peripheral artery disease, no matter the color of their skin.
 
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