One for Nick - Blisters or Ulcers....?

Doug came home a couple of weeks ago with a blister on his foot. Nothing unusual about it, but no reason for it. Socks/shoes the same ones he usually wears, but there was nothing "special" about the blister - until it burst!
There was a fair bit of clear liquid (nothing unusual there), then blood, then it scabbed over and any soreness went.

A week later, there was another small blister on his toe - it was really painful so he went to the doctor and was given antibiotics and some cream to rub on his feet.

This little blister disappeared, but then the whole of the underside of his heel bubbled up, burst and fell away . He was given more antibiotics, but the heel is not healing.
While I was dressing his heel the other morning (he's been dressing it so he's able to walk at work - but once home it's open to the air), I noticed a small red mark on his ankle. He informed me this morning that this red mark has now opened up the same way his foot did.
He's travelling home this afternoon so I'll be able to get a better description, but could these "blisters" actually be ulcers?

I'm trying to get an appointment for tomorrow for him (and Bekka who has a chest infection), but the last doctor he saw had no idea what it was.

Hi Clare,

Sorry for the delay.. what with sheep and humans I had my fill over the weekend !

I guess to start with to say that at least the blisters or bullas didn't contain pus and that it was just clear presumably serus fluid!

I've been looking at various articles re this... first of all try this
http://en.wikipedia.org/wiki/Diabetic_bulla
I am not sure that they are that common but often resolve in 2-4 weeks.
http://onlinelibrary.wiley.com/doi/10.1046/j.1365-4362.2000.00947.x/full
has a few more details and say that it is rare and as a result of a staph bacterail infection.

Unfortunately I can't get into most of these articles to read the whole thing (sorry)

http://onlinelibrary.wiley.com/doi/10.1111/j.1742-481X.2008.00476.x/abstract
Try this one and you could worry yourself to pieces (or not) diabeticorum is if memory serves right far more prevalent in women than men

http://books.google.co.uk/books?hl=en&lr=&id=mKj1MLUnlekC&oi=fnd&pg=PA48&dq=diabetic+plantar+bulla&ots=_Y2dNIXUTh&sig=kdh_Bw6LJ_vUXbp-LW8aXQrtEDw#v=onepage&q=diabetic%20plantar%20bulla&f=false

speaks for itself with some great pictures!

Obviously a lot depends diagnosis wise on what his HbA1c's are like, degree of neuropathy and the usual miriad of other things that may be presenting with his foot (appeareance/retracted toes/blood supply both arterial and venous) etc etc etc

Hopefully Derriford can come up with a diagnosis and quickly for you and yes it could be an ulcer but that isn't the usual way that they present at all.

Let me know how he gets on please and if I can help any more...you know where I am
(even if it is to explain the words!!)

N

Thank you - looks like I've got a lot of reading to do

Well the original "blisters" all cleared up ok, but he was taken into Derriford yesterday because the sore he had on his big toe had become really badly infected. He'd been seeing the doctor about it every week and was dressing it as they prescribed. He's been on three lots of antibiotics and this thing just grew and grew.

Hopefully they'll work out today whether the pulse is strong enough to save the toe. They scanned it yesterday and the infection hasn't reached the bone......yet.

Fingers crossed he'll be able to keep it.

Hi Clare,

Coincidence I was there yesterday too !

Good that it hasn't become osteomylitis... have they actually diagnosed yet what was the cause of these?

Fingers crossed re toe, they definitely do not like taking anything off and especiallya s this sore/ulcer whatever isn't healing, I am sure amputation will be a last resort.

Take care and pass on my best wishes to him

Nick

They haven't said what caused it, but the drugs are definitely doing their job. He looked much better tonight and his blood pressure has started to come down (it was stupidly high yesterday), his bloods were 6.6 which is fantastic for him and he's a lot more relaxed.

It looks like the toe will be ok, the swelling in his foot has come right down and the smell has almost gone. We'll know more tomorrow.

And now to sleep.......

Great news

thanks for the update Clare....hope it continues in this light

They packed the hole with "putty" this morning and he's got another scan tomorrow, but it all looks really good.

But then, if he'd sorted it when I told him to.......

Ahhh well you can lead an animal to water.........

He said that he felt a bit "odd" earlier today so they tested his blood - it was 3.3
Needless to say they gave him some glucogel and a couple of handfuls of jelly sweets and he felt a bit better. It was 4.6 when they tested it at 6 tonight. (he usually tests between 7 and 11 now that his meds have been sorted)
I took him in a pizza and some maltesers - as prescribed by the doctor and left him happily munching away on a deep pan super supreme

Ok I am just wondering what quack would prescribe pizza and maltesers for a diabetic.....

Words fail me...although I am sure he enjoyed them

Perhaps equal protein and carbs might have been better?

3.3 is wayyyyyyy to low, nice to see that they are checking him regularly

They've been checking the bloods every two hours. He needs to learn to snack - it's not something he's ever done, he usually grabs a sandwich at lunchtime and if he's hungry in the evening he might have something to eat.
Now that he's in hospital and is eating regularly the insulin is working properly (hence the sudden, rapid drop).
The pizza I took in was only a medium (not even enough to fill my youngest), but he was having half (3 slices) for his dinner and he'll have the other half for his lunch tomorrow.

The staff have been absolutely fantastic, and he's finally getting the rest that he's needed for the last 2 years (he's had one weekend of since Christmas )

Good to hear that things are progressing Clare

Spoke to Doug this morning and it's not looking as bright as we thought.
The infection [ijhas[/i] reached the bone (they used a more powerful scanner), so they will, either tomorrow or Thursday, be removing the toe down to the first joint.
Now he's all in a panic over whether they'll do the op under general or local - they're talking about it just being a local.

So things are a bit stressed again

Oh bottoms !

Really sorry to hear that Clare, I truly am. Even if it's under local he won't feel a thong as they will ring block his ankle and entire foot and use very long acting local anaesthetic that is excellent. It saves him being put under and addition stress on his body and blood sugar levels.

Fingers crossed for him.

Take care
Nick

I hope he won't feel a thong because if he does it would belong to one of the nurses
He's putting on a brave face and the lads from work have all been keeping his spirits up, he just wants it over and done with now.

I can't praise the staff highly enough, they've all been so good

They hand out thongs as part of nurses uniform????

Gosh ????????


Yes I can imagine that he wants it all over and done with

Wishing you both...... all good luck and success for tomorrow
xx

I was just quoting your previous post

I'm sure everything will be fine.

xxx

Well, the op was booked for 4pm today and at 4.45pm today it was cancelled
Poor Doug was starving hungry, he had been told not to take any insulin and was getting very shaky and was sweating like a pig. He's nil by mouth from midnight and they might be able to fit him in in the morning........or Friday.......or Monday. He's now really depressed and talking about coming home.
I explained as calmly as I could that if he comes home for the weekend, there may not be a bed for him on Monday, so he's better off staying where he is - he just thinks I don't want him home.

He's got a week of total bedrest when he does come home, then they've told him that he can go back to work.
We're sterilizing the house tomorrow and Friday and pretty much turning the bedroom into a hospital room. I'm not looking forward to changing the dressings

Oh Clare

What can I say???

I do despair for you and Doug.

What the hell is wrong with them? I mean how difficult is it to actually treat the patient and not the BLODDY patient number!????

Anyone reading this would or should think that the staff are totally incompetent!! How they cancel a person's op like this?? I truly think this says more about Derriford than anything else!

Truly words other than cursing fail me !!!!

Oh hun I wish I could offer true words of wisdom and condolence etc but I am so bloody mad for you I can't.

OK maybe this is actuallly fueled by my own feelings of anger against them by the way they have treated me....but this is sooooooo wrong.

I can't see how he can go back to work after a week after an op like this?? What the hell is the matter with them ?????

Please anyone else reading this tune in and add a comment???

If you have any problems with dressing s Clare let me know.....I'll help you.

I'll send you a personal email with my contact details OK??

Feerling for you both soooo much

Nick

Thanks Nick, I'm really surprised at them cancelling the way they did, I'm a bit of a Derriford fan (they brought me back twice while I was in and I can't praise them highly enough), but this has hit us both pretty hard.

I agree that a week away from work is a really short time, but unless they take him in and strap him down, there's no way he'd stay away.

I can handle the dressings, but it'll be weird as they won't be stitching the wound, but packing and dressing it. I've had to deal with much worse. Doug's in the middle of his paramedic training so dressings are a hobble in the park for him.

I'm just sad that he's got to go through the whole build up again - at least he should know by about 10am tomorrow, which will make things easier.

Oh well, now to bed.......With luck I'll actually sleep tonight

Ok, so it looks like the op will be on Monday. He's coming home later today and I've got to take him back on Sunday night. What a f*ck*ng pain in the butt

I'll echo that !

I cant believe they have messed you both around so much over this...

Fingers crossed that everything goes smoothly and on schedule Monday.

I picked him up Friday afternoon and he was very good (he went straight to bed as instructed by the doctors). Then I had to take him back in yesterday lunchtime so he could have his IV antibiotics and the dressing changed. It looked so much better than the last time I saw it - and the smell has completely gone.
I've got to have him back by 6 tonight so that he's ready for the surgery that is to be done on Monday morning

They're hoping that if he recovers from the local ok, he'll be able to come home Monday night. I'm hoping they'll keep him in for a couple of days just to make sure everything's ok.