Problem with Diabetic ulcer healing

[gbswales]

Since the end of February I have had a diabetic ulcer on the back of my ankle. I have always taken good care of my feet inspecting them reguarly and when the back of my ankle became sore I visited my doctor who presecribed an anti biotic cream and I also covered the area. Despite the fact that there was no visible wound initially it became infected and continued to get worse despite various antibiotics. The situation now is that I still have the ulcer which causes quite a bit of pain and is preventing me from driving. I am having it dressed twice a week and every 3 weeks I see the tissue viability clinic. It have regular swabs done and it shows no sign of infection, but little sign of healing either. I am monitoring my sugar levels closely and keeping it in single figures, erring towards too low than too high (last months average 6.3) I have backless shoes and slippers and during the day wear a tubi grip stocking to help improve circulation. I do have neuropathy though still have sufficient feeling to be aware of any injury.

The only advice I am given is to keep having it redressed, to both rest and exercise!, and to accept that it will just take a long time! It is now putting my employment in jeopardy as the inability to drive, stand for long or walk up and down stairs easily has meant a combination of working from home with an occasional lift in by colleague or taxi. I am over the official retirement age but if I were forced into retirement because of this before 2014 when I intended to retire, it would be a financial disaster for me.

You can understand why therefore I am anxious to try anything that might speed up the healing process. I am wondering what experience others have had and whether there might be alternative treatments out there which could help. To give an idea of what is involved I have a picture but rather than present this to everyone (as I know some people are upset by graphic images) I have uploaded to my drop box. If you feel you might be able to offer some advice and need to see it please visit this web page
https://dl.dropbox.com/u/134019/ankle.JPG

I appreciate this is not a medical forum but would it be worth my seeking alternative medical opinion

 

[noblehead]

The only advice I could give is to ask your gp to refer you to the Dermatology Clinic at your local hospital, apologies if you have done this already!

 

[gbswales]

The only advice I could give is to ask your gp to refer you to the Dermatology Clinic at your local hospital, apologies if you have done this already!

Thanks - I had kind of assumed that "Tissue Viaiblity clinic" would be one step up on dermatology but none the less worth exploring

 

[viviennem]

Ask about honey. I had a friend in Swansea who used honey, which helped. I'd ask first, though.

My Dad had them; he went to Yugoslavia on holiday - 2 weeks on Slivovitz and they were healed! :shock:

Broke out again later, though.

Viv 8)

 

[Sarah69]

I really don't think circulation makes a difference. My mum (diabetic) with very good circulation had leg ulcers a few years ago, she was off work for over 6 months. I can't remember how they were treated but on one occasion her leg reacted to whatever was put on them and it made it 10 times worse. The we're bandaged from foot to knee the whole time.

 

[WhitbyJet]

Yes I have heard that honey is good for wound healing, Manuka honey, there are dressings called ComVita, but they are expensive and I think mainly used in private hospitals.

My aunts penfriend in France has had a slow healing ulcer and was successfully treated with 'Nexagon' gel, I googled this out of curiosity, sure enough it seems to have good reviews.

You mentioned alternative treatment, there is a link on pycnogenol, some people take this supplement to help with retinopathy but its also used for wound healing http://www.nutraingredients.com/Researc ... er-healing.

You already keep tight bg control, thats very good, make sure you eat foods containing lots of vitamins C and K, antioxidants and good quality protein, all of these will help tissue repair and healing.

All the best, hope you get better fast

 

[iHs]

Although my friend is no longer alive unfortunately, she had leg ulcers that were much worse than the photo shown in this thread.

Her problems were caused through very very high bg levels constantly which were not tackled as they should have been, and so leg ulceration was common.

She eventually become antibiotic resistant and gangrene often set in and was dealt with using medically bred maggots (from Wales I believe) which got rid of the gangrene but the tissue left still took an extremely long time to heal. Not knowing whether amputation below the knee would be a better option, I had a good look on the internet and suggested that she probably had nothing to lose by trying pure honey. She found a bee keeper within travelling distance of her home and bought about 2 jars of honey straight from the bee hive with the waxy crust on the top of it. Bee keeper said that imported Manuka honey would do nothing as it has lost all of its healing properties and that local pure honey would work. Guess what...... he was right.... within a few days the ulcer wound started looking a bit more healthy and was starting to heal.

I can only suggest that you think about finding out a bit more about the healing power of honey

 

[gbswales]

The mention of honey is encouraging as the nurse at my local clinic said on Monday that she was ordering some honey based dressings to try on it - I should have some by Friday this week. I looked into the maggot treatment but this is only incidated where there is still infection present and successive swabs have revealed it free of infection.

I have also found out about a new product developed in Cuba which has recently been licensed for production in Spain but have not been able to find out anything about it in the UK - http://heberprot-p.cigb.edu.cu/

 

[minitata]

I had what was first thought to be an ulcer on my ankle. I had it dressed each week and had to keep it dry etc. I started taking Iodine as a supplement when it had been going on for several months and that helped it to heal. Once I was allowed near it again - without the dressing - I used zinc and castor oil cream and that helped it too. It turned out to be a sore due to having such skinny ankles - though the only difference that made was that I don't have to wear support stockings - which fall down on my skinny legs - the treatment was the same other than that.

I find that I'm so slow at healing nowadays that any broken skin and I start taking Iodine tablets to speed it up - seems to work too.

 

[Hobs]

I am certainly not a skin specialist and as just a long term T2 patient I can't offer a qualified medical opinion. However, I will add that it does remind me of a friend's lower leg who suffers with Diabetic Dermopathy. The clue is the shiny brownish mottled skin pigmentation as he was told that is the first indication. I'm not saying this will work for you as no two people are the same, but my friend was asked to try the OTC ointment known as Germolene when all the rest failed, and eventually his ulcer healed. Since the first diagnosis of DD he has kept very tight control and excellent foot care + very soft and flexible footwear/socks with the effect that the ulcer has not returned.
If I were you, I'd give Germolene a try :thumbup:

 

[hanadr]

My husband has had several diabetic ulcers. He's always had them treated by one of the Practice nurses, who has wound care training. So far the quickest results have been when treating them with Manuka honey and a bandage NOT sticking plaster
Hana

 

[hanadr]

PS
I've never had an ulcer, but I have found that I heal at normal speed.[ I came off a bike and healed normally and without scars] I've put this down to VERY TIGHT blood Glucose control i e around 5 at ALL times
Hana

 

[gbswales]

PS
I've never had an ulcer, but I have found that I heal at normal speed.[ I came off a bike and healed normally and without scars] I've put this down to VERY TIGHT blood Glucose control i e around 5 at ALL times
Hana

Would that I had done that but like many new diabetics I went into a kind of depressed denial for the first couple of years. The other factor is that I had severe pancreatisis a few years ago so even keeping tight control the readings will jump up and down for no obvious reason. My original levels had reached almost 30 before the diabetes was even diagnosed and have no idea how long it might have been - the likelehood is that a lot of damage was done early on. I did improve the feeling in my feet by taking control so preseumably reversed it a little. Thanks for advice and I will see this weekend how the honey based dressings work

 

[viviennem]

I am certainly not a skin specialist and as just a long term T2 patient I can't offer a qualified medical opinion. However, I will add that it does remind me of a friend's lower leg who suffers with Diabetic Dermopathy. The clue is the shiny brownish mottled skin pigmentation as he was told that is the first indication. I'm not saying this will work for you as no two people are the same, but my friend was asked to try the OTC ointment known as Germolene when all the rest failed, and eventually his ulcer healed. Since the first diagnosis of DD he has kept very tight control and excellent foot care + very soft and flexible footwear/socks with the effect that the ulcer has not returned.
If I were you, I'd give Germolene a try :thumbup:

Just to add to this that not all mottled brown pigmentation on legs is due to diabetes. I have it on both shins, as did my father, and it started in my 30s, well before diabetes, so I think in this case it's genetic. It isn't shiny.

It's worse on my left leg, where the skin structure was badly damaged by a fall - a long story, but I scraped a hard metal rim right up the inside of the shin. No bleeding, nor broken bones (I was wearing thick socks, jeans and wellies) but I had the bruise to end all bruises and had to come off the Pill. I was also told that getting pregnant would kill me (thrombosis).

Since then I've had cellulitis twice in that leg, and bacterial infection in the skin. My GP thinks I have lipodermatasclerosis, which I don't want! I'm extremely careful of it because I think it's a prime candidate for a diabetic ulcer.

Viv 8)

 

[alandbailey]

I thought my type 2 diabetes was cured after DS bariatric surgery in 2004 - it was, but the effects of ED and neuropathy are still present and worsening.
I developed ulcers on 2 toes, which first responded to treatment with Manuka honey, but then became infected and started to turn black - NOT gangrene - 3 courses of different antibiotics had no effect. I developed cellulitis, erythema and induration - all very nasty and distressing.
I was advised to have the toes amputated as I had osteomyelitis which could spread to the whole foot and then to the leg - I had the amputation as I prefer malt whisky to make me legless, not a surgeon's knife! lol.
Unfortunately I now have an ulcer on the toe of the other foot - I am resigned to more mutilation.
Ask your GP to refer you to a vascular surgeon or other allied consultant - I see about 3 or 4 consultants regarding my condition - all say the root cause was diabetic neuropathy.
Time is of the essence - if mine had been diagnosed earlier, I might still have all my toes.
Good Luck,
Alan

 

[sue56]

I,ve had foot ulcers since I was 18 and am now 56 and have even had a skin graft that didn,t work so will not bother again. They are extremely difficult to heal and usually very slow. When mine have healed ; they always break down again even though sometimes it,s been over a year but what I have found helps me is, believe it or not is SUDOCREM ... the baby nappy rash cream

 

[catherinecherub]

If I had problems with anything to do with my feet I would ask to be referred to Kings College Hospital, London. Dr. Edmonds runs a "one stop shop" for all types of diabetes related foot problems and has an excellent team.
http://www.dailymail.co.uk/health/artic ... alist.html

 

[Ricky]

I also agree with Manuka honey - get the 20+ one. Other suggestions from me would be homeopathic Calendula cream and also Calendula pillules to take 3 x aday. Calendula is brilliant for healing. In the past I have also tried Propolis tincture. It seems to make a barrier so wounds can heal.
All the best. I would be interested to know what works for you.

 

[Ricky]

As a homeopath I feel obliged to mention that there are homeopathic remedies that deal very successfully with diabetic ulcers . I suggest that you see a classical homeopath for a full consultation to find which remedy would be best for you.

 

[gbswales]

Update - unfortunately the honey dressing did absolutely nothing, if anything it made it worse. A week or so later it got much worse having developed another infection and I ended up in hospital for three weeks on intraveinous antibiotics. I have since come home and they are treating with multi layer bandaging which they are still changing 3 times a week. By the time I was in hospital it got so bad that the archilles tendon was visible and extremely painful, Their concern was the bone but a scan revealed no infection there - it is slowly, very slowly healing again but I reckon (assuming the current rate of progress continues) that it will be some weeks before it is even close to how it was when I wrote the original post. tomorrow I am being seen by an orthapaedic specialist with a view to fitting a removable cast (something I suggested to them from a post here over three months ago!) with a view to keeping the ankle joint rigid to give it a better chance of healing.

I just feel so frustrated because so many of the things that I suggested over the months were brushed aside by doctors and nurse specialists who kept telling me it was fairly superficial and would just take time. Why oh why did they have to wait until it was visibly very bad before trying these things. In my view the NHS is incredibly short sighted when it comes to giving pro-active treatment. If I had been given a cast at the time when it was mainly a surface problem I think it might well have healed and would have avoided the cost of a 3 week hospital stay and countless trips to hospital by ambulance. Even in the latter they are shortsighted because I have a locally run voluntary car and driver service which charges about 40-50p a mile and nothing for waiting time - however they will not refund the cost of that, insisting on ambulance travel (ambulancee car or minibus) which I know is many times more expensive. Little wonder that the health service is critcised for its lack of efficiency. If they reacted as well to minor - medium issues as they do to a crisies, they could save a fortune as there would be far fewer critical cases in the first place!

For example they know in the early stage of diabetic diagnosis that people often go into denial so why not offer more support at that stage - with say weekly clinics in the first few months and even random visits by district nurses. Getting people to control more effectively in the early stages could save millions in later complications - you get more help giving up smoking than you do giving up the foods that you have loved all your life.