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Sores on legs

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Sheila of Eskdale

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If an elderly diabetic (80's) has sores on their legs should they be getting a regular visit from a nurse, say every couple of days, or is it enough for the doctor to give out some ointment. At the moment he's got some dressings put on by the nurse and another appointment on Friday but up to now its been up to my Mum to keep asking for appointments as things aren't getting better.
 
A very dear T2 friend nearly lost her leg after an insect bite got infected. It took over 3 years to heal and will never be the same again. I'd say a bit of ointment is not enough!
 
I agree with LeeLee. Maybe you could ask for an appointment with a specialist.
 
Not quite a sore, I had a golf ball size blister, and I had to go to the nurses every few days to ensure it was healing. If not it would of needed attention asap.

I would say the same would apply to sores as they could quickly turn ugly if a eye was not kept on them. They need to get them looked at asap and regularly checked until healed.
 
I agree with the others, very close attention needs to be paid to ensure things are healing. How good is his blood sugar control? If he suffers from high levels then it will take longer to heal.
 
You really need to push for a diagnosis with a dopler device to check blood flow in veins and arteries, to see if there's a problem with one way valves in veins not working as well as they should, or a problem with arteries, which don't have valves.

Depending on whether there's a problem with blood supply, and if so, with which type of vessel, the treatment / dressings / pressure bandaging will be different. In addition, and local infection will need treating with either topical (ointment / cream) or systemic (tablets) antibiotics. So, please push for a referral / proper investigation by dopler at the appointment on Friday.
 
Thanks for the advice. His legs and feet are very swollen which the doctor thinks is fluid retention. There is at least one varicose vein (it looks like one to me) on his leg. He is on anti-biotics. What doesn't help is that due to dizziness he insists on sleeping in a reclining chair so isn't lying down properly at night, I think that is also making him more stiff. Then between the dizziness and stiffness he hardly gets any exercise. So that isn't going to help the circulation in his legs. His sugar control is bad as he also has dementia so has no understanding of sugar control and even is he did understand it he may have no recollection of just having had a drink or food.
I'll get Mum to ask about the doppler test, as well as asking why he isn't getting treatment for his dementia, and pushing again for physio. It just seems like we have to battle to get everything and we are constantly having to deal with what is most urgent first.
 
Sheila of Eskdale said:
It just seems like we have to battle to get everything and we are constantly having to deal with what is most urgent first.
Click to expand...

Do not shrink from that battle. Their systems do not work properly. Patients are frequently forgotten about, hcps do not always follow procedure, papers go missing, notes are not updated, people change jobs and forget to pass on information and people assume others are doing something about it.
 
Yorksman is right. Don't feel you're bothering them when you call for appointments, or ask for help, it's what they are there for and you have the right. Your father can't care for himself which means you have to and his medical team should be paying far closer attention to what's going on with him. If you can't get the proper help there, is there another surgery you could change to - always supposing your father can be persuaded? Does anyone have Power of Attorney for him? (That is, supposing matters have progressed that far.)
 
Its not that we're concerned about bothering the doctors. Its a strain on my Mum having to help him all day and then also having to hassle the doctors. But also there's a feeling that if we hassle them about all the problems (sugar levels too high, dizziness, too stiff to look after himself after a fall in June, not getting medication for Alzeimers, oedema, sores on legs) they miss the stuff that's urgent right now. In reality I think they need to look at everything together, but doctors don't think like that they seem to see the body as a collection of bits and systems and seem to forget that its all linked together. If he got some physio, and sorted the balance problem he could get more exercise, that would help with the oedema which would probably help with the sores.
 
Hi Sheila, It sounds to me as if you need to sit down and write out a letter to your Dad's GP explaining what is going on and your concerns. Occupational therapists do home visits and can help with exercises for your dad, also aids around the home can be provided as can carers to come in and take some of the burden off of your mum.
Carers go into my dad 3 times a day and as far as my mum is concerned they are heaven sent. Having met them and seen how they deal with my dad I can not agree more. 🙂
 
Sheila, been going through a similar situation with one of my family and its hard work. It got to the point where I was calling doctors out night and day only to be told there's nothing wrong. Even the ambulance call center refused to send a ambulance. :(

After about 3 weeks of the daily / nightly ritual finally got a doctor to sort out what was wrong, the next time I rang 999 I got the ambulance that was needed weeks before, and diagnoses was confirmed. :(

Stick to it, I know its hard as been there, and hopefully you will get a doctor than will look at the whole picture.
 
As well as asking for dopler investigation of legs, I would also ask the GP to refer your relative to geriatrician / care of the elderly specialist, as this should link up with occupational therapy, day centres etc, and consider ALL their medical problems, not juts diabetes or leg ulcers in isolation.
 
Forgot to say, are the memory people involved with you in this as they should be able to help. Also the Admiral nurses provide excellent support for the cares or that's what I found with them.
 
Thanks all for the advice.
I'll check if there is a specific elderly care team in our area. I have a feeling there's not as I seem to remember them discussing it on the radio a while back that we needed one.
The mental health care team have been round, it was them who diagnosed him with Alzheimers and recommended that he get the medication to treat it. We think the doctor may be delaying giving him any new medicine until the balance problems are sorted out because he doesn't want to confuse this problem by starting him on new medication.
I've checked into Admiral nurses, they don't do my area, but thanks for the tip.
 
Just an update.
Dads legs are much improved, since Tuesday he's had some bandages on that are impregnated with zinc oxide, they seem to be making the difference. The infection also seem to have gone.

Just by chance I saw a thread on here about Necrobiosis Lipoidica Diabeticorum and told my Mum to look up images. She said that is what it looked like in the beginning before it became so infected, its looked like excema before that. The sores appeared late December and the doctor gave him anti-biotics then, he had given him cream for excema in the autumn but my Mum can't remember whether he actually looked at the legs.

I got the District Nurses (they don't actually call them that anymore) around to assess him and they are going to get him a doplar ultrasound test. They are the nearest we have to an elderly care team, they can refer people to other medical people and get professionals together to discuss a care plan. We don't seem to have a team that has doctors and physios etc.
There is a team at the hospital but their remit seems to be to discharge someone as quickly as possible. It was them that said he didn't have dementia when he did and refused to assess his balance problem after he was admitted due to a fall.

Can people who have an elderly care team in their area please give me details, such as what they comprise of, what they do and if possible what NHS trust it is and what the team is called. I want to push for something like that in this area.
 
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