Foot update 4 - not good news

[mk_steve]

Had follow up at the foot clinic this morning. Not the best of news. Not sure where I go from here.

Peripheral Artery Disease is the verdict by the vascular specialist. Whilst the scan didn't show any major blockage in blood supply to the foot, there is some restriction. Further, it is believed I have been diabetic for some time before being diagnosed and this has damaged the small blood vessels in my foot/feet; the poor blood supply to the tissues in the feet can give rise to ischemic ulcers. None of this was so bad until we began to discuss the future!

They plan to do some xrays in my leg and feet to see if bypass surgery will improve matters. There are apparently three arteries going into the foot and if any of these can be improved with bypass surgery they will. I guess you have to have something to bypass. If not then the outlook is "pretty grim" - consultants phrase not mine! That was a bit like a sledge hammer! That was about as good as the news got. My future suddenly caved in. "Pretty grim"? So where do I go from there at only 52!

So it's all down to an x-ray now and the possibility of a "pretty grim" outlook.

Depressing eh?

I normally have a positive outlook on things. Always being the optimist. I don't usually mind how bad it is; if there is some hope of making it better then I usually focus on making it better. This didn't offer much in the way of hope but more of a roll of the dice. It's all down to an x-ray of my foot.

 

[catherinecherub]

Hi mk-steve.
I cannot begin to know how you are feeling today. Hold on in there. I know that consultants mostly tell you the worst case scenario. They haven't got a crystal ball and people defy the odds all the time.
You say that you are a positive person usually and I think that is how to view this. Positivity doesn't cost anything and sees many people through their trials and tribulations. I am sure I speak for all of us when I say that we are all thinking of you and hoping for the best outcome possible for you.
Any time you feel low then come on the forum and speak to us. Having someone to listen helps me at times.
You can always p.m. people.
Take care,
Thinking of you, Catherine.

 

[hanadr]

Hi mk_steve
all that sounds very upsetting
I can't promise, but if you can keep those BGs ight down( in the 4s and 5s) things may improve. It's worth a try. You can do this. by reducing carbs or upping medication and monitoring to see that you stay within the safe zone. Put this to your Health care team and ask what they say. They may not think it can work, but it has in the past.

 

[nannoo]

Hi Steve. Things might not be too bad, so don't worry too much. PAD apparently affects around 8 million Americans, and by the age of 65, around 15 per cent of the population has it. As long as it is treated, you should be OK. Good luck, and keep us informed.

 

[mk_steve]

Thanks, i was encouraged by your post. I might just pm doctor Katharine and see what advice she might offer.

I did wonder, as some of you have said, whether the consultant was merely preparing me for the worst case rather than get my hopes up. I think I prefer it if they got my hopes up. Hope is a powerful motivator and when they begin to take it away it can be devastating.

I have read with interest the low carb advice given by many people. I am reserved and unsure. Given my arteries are "restricted" and the small blood vessels in my foot damaged (although they did say that sometimes they grow back - a smidgen of hope offered by the consultant!) by diabetes I am a tad scared of embarking on a diet of rich in things like bacon, cheese and eggs. I understand the low carb concept but it flies in the face of everything I have been brought up to believe (or some might say indoctrinated). I feel now that my health is like walking a tightrope with blood glucose on one side and cholesterol on the other; with diabetes on one side and Peripheral Arterial Disease on the other. Unfortunately I don't seem to get the support from my healthcare practitioners that I could do with. They do not seem to support a low carb diet and never recommend these food choices. They tell me to stay away from these foods.

To be honest I do not know what to do for the best. I know you all mean well but I get conflicting advice and don't know which way to turn. I am scared of further deterioration and hate the possibility of ever facing amputation; I do not know what is the best course of action and my diabetic nurse, gp, podiatrist or the vascular consultant just aren't helping me with a viable plan; instead they poke the foot, scan it, x-ray it and use phrases like "could be pretty grim".

What is guy to do?

 

[hanadr]

Hi mk_steve
One extra point to make you feel better.
It's NOT fats that cause cholesterol, but CARBS, so you CAN have fats. they WON'T't block your arteries and WILL stave off hunger.Ditch the cereal breakfast and have the fry-up. You'll enjoy it and feel great. And won't be hungry before lunch.

 

[saz1]

I am a tad scared of embarking on a diet of rich in things like bacon, cheese and eggs. I understand the low carb concept but it flies in the face of everything I have been brought up to believe (or some might say indoctrinated). I feel now that my health is like walking a tightrope with blood glucose on one side and cholesterol on the other.

Unfortunately I don't seem to get the support from my healthcare practitioners that I could do with. They do not seem to support a low carb diet and never recommend these food choices. They tell me to stay away from these foods.

To be honest I do not know what to do for the best. I know you all mean well but I get conflicting advice and don't know which way to turn.

I know exactly how you feel. I'm newly diagnosed myself, a healthcare professional and very much brainwashed to low calorie, low fat mentality after all the health education and weight loss attempts. But physiologically low carbing makes perfect sense but goes against all advice around. But like said, read Bernstein and atkins books and it will be like an epiphany. I'm still struggling with having double cream, cheeses and butter in my fridge... But I don't get hungry like I used to and am satisfied after meals and losing weight rather nicely.

I think I'm quite lucky with my practice nurse and gp, they are both advising to reduce carbs but also advise low fat too and I was told to learn to smile and nod. Then carry on doing what I'm doing. To me there is enough evidence here in members' blood results for me to give all this a good go! Just remember, sooner you get your sugars down, sooner the complications can be halted or even improved. Look at peoples signatures and that's the best advice and evidence that low carb and high fat diet actually reduces cholesterol and triglycerides so no clogged arteries! As long as you eat vegetables of all sorts of colour with your meats, cheeses, and sauces you will feel so much better!!

Good luck and keep fighting! I am determined to prove all the predictions wrong, many people here have helped me to see the sense.

 

[phoenix]

Sorry to hear of your diagnosis. Hopefully when you have had your Xrays you will have better news..

Always being the optimist.

Try to continue to be the optomist. I wonder if you were so shell shocked that you did not take everything in. Even if a stent is not possible and they need to bypass, as I read it, it is often possible to use plastic tube if no suitable vein is available..

Meanwhile, you are in a dilemma as to which diabetes advice to take.
Firstly, your BG levels need to be controlled asap. Your doctors should be prescribing you whatever medication is necessary. Hopefully, you will be prescribed enough strips for you to discover the effects of various foods on your own BG levels.
Now I will be controversial and add to your confusion. I thought over night about anwering this post because I know I differ to many people on this forum.
I feel that reducing saturated fat is very important, though consumption of other types of fats (as in oily fish,olive oil, avocados) may be protective. I have read huge amounts of evidence from both sides, but I am not convinced as to the safety of a diet high in saturated fat for someone with CVD. This forum only contains anecdotal evidence and is mostly of short term experiences. Have a look at the book by Gallop on the GI diet as followed by Catherine Cherub and Tubolard to see a different approach that works for their diabetes, is nearer to conventional advice and may be more acceptable to your doctors, and you will have to work with them..
Lastly, and perhaps most importantly, from what I read, there are 2 factors that can really help with PAD. One is not to smoke. The second is to exercise.... walk if possible, taking care to wear good shoe with no pressure spots that might lead to blisters. Check your feet daily .
Here is a link to an article on exercise and PAD http://thediabeticnews.com/news/1453.shtml
and a Canadian site on PAD with various sources for patients.

http://www.padcoalition.org/Good luck,

 

[catherinecherub]

Hi mk-steve,
As a follow on from the excellent post from phoenix.
I lost my husband in 2002 and the following year, prior to a diagnosis of diabetes, I suffered a heart attack. I was now a widow with three teenage boys, had suffered a heart attack and was now being told I had diabetes. My world did not look very rosy and I was scared of what the future held.
I was lucky in that my diabetic nurse suggested the G.I. diet for me and, touch wood, it is working. I do limit my carbohydrates but would describe myself as a medium carber and I do not eat the amount of saturated fats that low carbers do. Following this diet does not mean that you actually count carbs but portion sizes for carbs have to be adhered to. It is a diet that pleases my cardiologist and me. I feel really healthy and six years on am still able to control my blood sugars by this method. The book that I use is The G.I. Diet by Rick Gallop. The author is a cardiologist so I think that helps me to think that this diet is the best one for me.
If I had not had such excellent advice from my diabetic team I cannot say what the future would have been for me or my children. I also think that this forum provides excellent support and advice for all diabetics at whatever stage they are at. The main secret of good control by whatever method is being able to test your response to different foods. Even with the G.I. diet there are some recommended foods that raise my sugars too much. We are all different so there cannot be one way of controlling this beast.
I have to say that if I had been unsupported by my diabetic team and had found this forum at the start of my diabetic journey I would probably followed the low carb plan because the low carbers who post here have excellent results .
There is no right or wrong way to do it, we are all different and that is why you are the only one who can decide what is right for you. You have to make an informed choice.
No one knows what the future holds as most medics say it is a progressive disease but if we manage it to the best of our ability then at least we can say that we tried our best and that is all that any of us can do by whatever method.
Regards, Catherine.

 

[Trinkwasser]

In a nutshell, your specialist is probably putting the Worst Case Scenario because he is used to diabetics progressing rapidly, which is common on the Heart Healthy Diet.

There's plenty of evidence of major improvements IF you can get your BG down. At least it will help majorly in not making things worse.

Body fat is bad. Blood fats (lipids) are bad - in excess. Dietary CARBS not fats are responsible for both of these. Well actually dietary fats *in the presence of excess carbs* are bad, without the excess carbs and excess insulin they are metabolised quite differently.

You may care to use more monounsaturated fats, Omega 3 polyunsaturates (fish) and some Omega 6s and keep the saturated fats down. I actually convert saturated fats into HDL (good) cholesterol rather than LDL (bad) in the absence of the carbs and triglycerides, not everyone can do this but it's commoner than you might expect looking at numerous blogs not primarily concerned with diabetes.

Pleanty of veggies with bioflavinoids and antioxidants (look at the Eat The Rainbow thread) and as much exercise as you can manage should also have favourable effects.

Now get yourself out there and prove the guy wrong!

 

[mk_steve]

Hi,

I am encouraged by the replies to my updates and I will embark on a low carb diet to bring my blood glucose down to a consistently low level.

I do feel that I am battling with the NHS to get some treatment for my foot. I feel abandoned by the NHS. People look at it and "assess" it; I have had numerous "experts" in their field examine my foot and the scans. But no action other three weeks of anti-biotics! The necrotic site is getting larger and is believed to be the result of poor blood flow to the foot. When I was in hospital they did give me a course of Heparin to "dissolve" any clots but this has had little or no effect. As I previously reported my last examination by the vascular surgeon only ended with a possible "grim outlook".

They must clearly understand this will conclude with amputation if not treated quickly to save the foot. It feels to me like they are waiting until the foot cannot be saved, passes the point of no return, and will then just chop it off! That's how it feels. I cannot believe that is their only plan. Right now if they lopped off the little toe it would remove all the necrotic area and surely that would be better than the whole foot! Problem with that though, is it would leave me with a wound that probably would not heal - poor blood flow in the foot!

I am seeing my gp Monday (couldn't get earlier) to tell her I feel abandoned by the medical profession because no one seems to be doing much anytime soon, and all the while this just gets worse and worse.

Hope is a powerful motivator but they are constantly eroding any hope by doing nothing. Not sure what I am supposed to do, sit back and let nature take its course or what?

will update you next week.

 

[heidiphillips]

Hi Steve,

Keep up your spirits. If there is the option of bypass surgery then there is a good chance it will improve the collateral circulation to your foot. As to low carbing - I have seen a number of people who swear they cannot go 'low carb' because they feel 'hypo' when their sugars drop below what they are used to. Why not try it a little slower? Reduce your carbs gradually so your system adjusts to the new levels. Worth atry?

 

[Sherman]

Hi Steve, couple of points,firstly some people in the medical proffesion sometimes seem to paint the blackest of pictures and yet when challenged often things are not as bad as they first appear.My wife was told by a physio therapist that she probably needed Knee replacement surgery,on the next visit he denied saying it!!!
Sometimes when they speak they are just thinking out load without thinking of explaining the full situation to you.
I can remember when my wife was pregnant and having a scan the operator would say things like
"oh I cant find a head" or "cant find a heart beat..........oh its allright there it is"
On to diet.....! was daignosed with type 2 10 years ago,my consultant said I would probably be on Insulin within 5 years, I have only just gone onto Inusin after 10 years.
I have always kept my bllod sugars low av around 5.6. I have also ate healthily avoiding to much fat.
My advise would be to eat healthily ,a balanced mixed diet,cut out all the sugar you can ie drinks,no bannanas,grapes,fruit juices. Eat less but often.The old way is best I find....Breakfast,elevenses,lunch,afternoon tea,dinner and supper,yes six times a day. As your sugars go up get your doc to gradually up your meds, diabetes is a chronic disease it does not get better,but you can slow it down. Dont agree with the fatty breakfasts Im afraid nor do I agree that all carbs cause you to get fat. I eat lots of veg and friut but aviod to much bread,potatoes,rice,and pasta which I find puts my sugars up as does too many potatoes,so keep these down.
I was 18 stone when I was diagnosed with diabetes,I came down to about 12 and a halfon a healthy/no sugar low carb diet and have maintained that weight,hence the slowing down of the progression on the disease.
Also exercise is essential,walk,swim,or just keep moving!! I "potter" a lot anything to keep moving is better than sitting around for too long,especially after meals.
Hope this is of some help.
P.S.Touch wood I have no complications as yet.

 

[sedge]

And reducing your blood sugar can actually make neuropathy seem far worse for a period (more painful etc) and THEN - it starts to get better!

And re PAD - my GP tells me that walking is by far the best thing anyone with PAD can do cos it helps the blood vessels proliferate. So assuming your legs hurt after a short period (as mine do) you have a rest then carry on a litlle bit. Then you do it again. And it gets longer before you feel the pain. That's the theory and it certainly works for me anyway! If it's only yards - doesn't matter. Just add 2 or 3 more steps - or as much as you can manage. You don't have to increase every day, wait till you are pretty comfy. Cos remember - you need to walk back too!

Good luck.

 

[Insulinman]

Hi All
Hope this might help

I had a bad pain in a toe right leg, one toe had a star craze
it was Hospital treated with Hi Tech antibiotics
Later a vascular Mr said it was a "bit of crudd" its called Diabetic Foot?
The BDA in those day gave advice one was foot exercises as below.

Sit on a chair, both FEET on the ground:
One foot at a time heel hard down on the floor lift the toes up!
This HURTS like hell start with 5 or 10 goes, increase when you can
again same foot, Toes hard Down lift ancle up!
Hurts but not so much start with 10 to 15 goes
I did this for many months when I got to 100 Times.
My foot Pain went away? I still sleep with loose Blankets on my right hand side so I can hang my
foot out of the bed (even in very cold weather???)

I am on Insulin Lot of it, Now its in a Pump!
and thank God I still have my feet
Like the other guys Quote "I want to die with my feet ON"

 

[smcc]

mk_steve

There are two different types of blood vessel disease in diabetes.

The first is a macro-angiopathy which affects large and medium-sized arteries and is the result of cholesterol plaques leading to narrowing of these vessels. This type of disease is not limited to diabetics and is very common in smokers. The severity can be assessed by angiography ( X-rays of the arteries), and can be reduced by lowering cholesterol levels. Angioplasty (stretching of the narrowed part of the artery) or by-pass is sometimes possible for these blockages.

The second is micro-angiopathy, affecting the small arteries of the extremities. The reduced blood supply means that small breaks in the skin are likely to become infected, and take much longer to heal. No X-ray will show this variety of blood vessel disease, and the only thing which might make a difference is tight control of blood glucose. It sounds as if you will need to work hard on this.

All the best in your time of trial.

 

[Anonymous]

Hi Steve, not logged on for a few months and saw your problem with your foot. Good luck. Had problem similar to yours, not diagnosed and damaged caused to nerves in feet, not blood supply, similar problem with pain, somebody with a needle stabbing my feet, burning, heat, very painful. Tried acupuncture which worked for about six months then pain got worse. Was given a drug called Lyrica (Pregabalin) which I now take twice a day, pain virtually disappeared, feet still uncomfortable but no more stabbing. Hope this helps.

 

[susie22]

Steve
Things will improve (I speak as the parent of a 14year old type 1 diagnosed at 3) one way we have found of controlling his blood sugar is eating from the low GI diet cookbook, on first glance its fairly off putting but get past the cheesy photos (both of food and authors) and 1 or 2 seriously dreadful founts of wisdom and its really quite good. Its by Anthony Worrall Thompson.
One great piece of advice I got was all diabetics are different and just because something may work for a number of people and the hospital is pushing it it doesn't mean it will work for you, listen to what your body is telling you