TOE AND FINGER ULCERS

[grahamp]

I have been a Type 1 diabetic for 44 years the latter of which have been plagued by a variety of serious health problems as a result of one of which I have been on a continuous course of oral steroids for the last 6 years (dosage 15 - 35 mg daily) which have contributed towards unstable blood sugars, skin thinning and bone damage. In 2007 I developed an ulcer on one toe that lasted 8 months but did heal following weekly visits to see the diabeticare podiatrists. During Feb./March 2008 it came back again and soon after I developed one on the end of a finger both on the left side of my body.

I was initially referred to a vascular surgeon during 2007 who advised no action as the vascular system was in reasonable order. I was re-referred to him during late October 2008 at which time he suggested and implemented a continuous 4 day intravenous course of Prostacyclin infusion to dilate the blood vessels and improve circulation in hands and feet - I received this course of treatment as an in-patient from 24th November however it did not result in any improvement to blood supply to toes or fingers and it was then proposed that Regranex cream be applied daily to both digits and treatment with this commenced on 21st December.

During January there has been some apparent improvement to the finger but the toe ulcer has got progressively bigger and then last Monday the podiatrist found that the bone in the toe was exposed.
a clinic doctor and by the vascular surgeon who has now requested that an angiogram be carried out to determine whether an angioplasty (stents) may help.

I am I think justifiably concerned that coming up for two years after suffering the first ulcer and having received continuous support and treatment from podiatrists I am now in a potentially serious condition: XRays revealed some time ago that the blood vessels in the foot are seriously calcified; a Doppler scan of the legs revealed that the lower leg arteries are not good and worsen towards the foot whilst the upper leg blood supply appears to be good and 6 years ago I received a triple heart by-pass for similar reasons.

Before I commit myself to something that may worsen my condition or not help at all I will appreciate any suggestions that I should consider and/or raise with my medical advisors before I agree a next step - Any ideas please will be welcome?

 

[sugarless sue]

Hi Graham,welcome to the forum.Please do not think that we are ignoring your question it's just that it needs an expert answer and probably none of us on-line tonight are qualified or experienced enough to answer your question.I am hoping,however that you will receive an answer in due course.

 

[Katharine]

Hi Graham,

I think they are trying to save you from getting below knee amputation. The chances don't sound that high especially since in diabetes there is usually a mixture of small and large vessel disease. It does sound, however, like it is at least a chance. You are entitled to ask for a second opinion from your medical carers.

This must be very stressful for you.

Katharine.

 

[grahamp]

Re: TOE AND FINGER ULCERS - VASELINE TREATMENT

An update regarding my toe and finger ulcers. I had an angiogram on my legs but the damage appeared to be in the peripheral vascular system affecting my feet and hands and there was therefore no treatment that would help prevent ulcers forming. However, when I attended the Diabetic Podiatrist clinic on 4th Feb. they found that an infection had spread from my toe into my foot and lower leg. Two days later I was in hospital on antibiotics and the following Wednesday they amputated my toe and half of my ring finger. I am now waiting to see whether these heal!

There was some good news in that whilst in hospital my vascular surgeon suggested the use of a Vaseline type, heavy duty, long lasting treatment for my continually dry and badly cracked fingers and feet - My wife found a new? product 'Vaseline Intensive Rescue - Relief and Repair Balm' which "promotes the ideal long term environment for even severely dry skin to repair itself within 5 days". I have been using it whilst in hospital on my cracked fingers and it has been as good as it's word and the cracking I had has healed my finger cracks despite poor circulation and steroid damage which have been previously inhibiting or preventing skin repair! I for one will be continuing to use this on feet and hands every day from now onwards! Any one wants to give it a go please let me know how you get on?

 

[sugarless sue]

I'm glad to heard that you have solved the problem of your cracked skin,it must be a relief to you.I hope that the wounds heal up as well.Keep us informed of how you are getting on.

 

[hanadr]

It's sad you had to lose a toe and part of a finger. What sort of HbA1c s have you had in recent years?
It's damage done by too much circulating glucose, which is often a cause of this type of problem. It's a pity, that you were not put onto an aggressive blood sugar control programme. that might well be your route to avoiding further amputations.
If you can keep your BG at non-diabetic levels, your system has a chance to heal. You need to aim for the 4.7 which is normal non-diabetic BG.
It can be done , either by aggressive use of insulin. I would ask for a pump in your circumstances. or by severe carb restriction. ANd frequent monitoring

 

[grahamp]

Many thanks for the comments and in response to Hanadr's questions my HbA1c's have never ever been good and it was as a result of these that I was provided with a pump 3 years ago; which whilst having improved my control has never got my level down below 9. My diabetes is quite fragile and sugars can drop rapidly, within an hour by 4 - 6 whatevers??! Additionally my insulin absorption is bad and it seems to take 4 + hours to be effective after eating so I also take Metformin to try to speed absorption up. Then the steroids screw things up even more with a dose that can vary between 15 and 30 mg a day and despite 7 years of looking no alternative to oral steroids has been found to control my cough- The Buteyko breathing technique has been suggested as a remedy for a chronic cough (mine has resulted in hundreds of cough syncope fainting episodes since 2003) but finding a Buteyko trainer in North London/Middlesex is proving hard to do.

I do test a lot (4 - 6 time a day) which is another issue because I don't want to keep pricking fingers - circulation is bad anyway and fingers are badly marked and not in good condition. However when I use fore arms they bruise very easily as do ear lobes and stomach.

Notwithstanding this I have been diabetic for 44 years and until recently walked almost every day or cycled. It is only now that I am out of condition, but once healed my dog can be woken up from her hibernation and taken out for walks or cycle chasing runs again!

 

[saz1]

So sorry to hear of your problems! Hopefully the treatment you have received plus the creams will mean a better future! It's a pain with the steroids, they can totally throw your body even more out of sync. :roll:

Good luck and keep us posted!