October 22, 2010

Diabetic Wound Care of Feet

If this was not so serious, maybe we could all laugh about it, but taking care of foot injuries is very important if you have diabetes and no laughing matter.

Day 1 – stub your toes on the bed as you are hurrying to the bathroom. Nothing shows when you inspect while in lighted bathroom.

Day 2 – large red area on the two toes you banged the prior evening. They are tender, but you put your socks and shoes on and go to work. In the evening, you notice a spot of blood on the sock, so you wash the feet and go to bed.

Day 3 – toes are tender and inflamed, but you go to work anyhow. In the evening, more blood on the sock, again you wash your feet and spray a little antibiotic on the area.

Day 4 – toes are inflamed and very sore, painful when touched and a crust has formed over the bleeding area. You decide to tough it out as tomorrow is Saturday. Evening finds sock soaked in blood and another stain. Wash despite the pain and apply antibiotic and cover. Sleep is difficult as foot is sore now.

Day 5 – wife wants the lawn mowed, so you start, but cannot get far. The pain is too much and when you remove your shoe, the sock is a mixture of blood and more stain. Wife see this and decides to clean the area, apply antibiotic, and cover it. Now she tells you to get the yard mowed as her sister is having a surprise birthday party for her husband at 4 o'clock, and she does not want to be late. You do as told and are able to stay off you feet the rest of the day, but at home, tired and very sore you just fall into bed.

Day 6 – Wife wakes you for church, but you cannot stand on the foot. It is swollen and inflamed. You decide to go to the emergency room. There they clean and disinfect the wound, give you an antibiotic shot and a prescription for more antibiotics, tell you to stay off your feet for a few days. They tell you to see your regular doctor, and tell you not to work for a few days. You forget to tell them you have diabetes, don't see your doctor, and don't fill the prescription.

Day 12 – you wake in the hospital and realize that you are missing your foot. The doctor is telling you that they have saved your life and that the foot and part of the leg was a small sacrifice to be able to save your life.

The above is not a true story, but it could be. If you have diabetes, any small bruise, minor cut or scratch could end up putting you in the above story.

The importance of wound care cannot be emphasized enough, especially the lower part of the legs and feet. Even if your diabetes management is excellent, accidents do happen. For understanding the stages of wounds, burns, and the healing and treatments, see this article by diagnose-me dot com.

Then there are those that think nutrition is the end-all for people with diabetes and go to extremes to promote it as the only way of managing diabetes and try to scare those who don't manage diabetes with nutrition as poor candidates for wounds and other problems as they don't practice good glycemic control. Yes, nutrition is important, but exercise is also important and taking your medications if you cannot control diabetes with exercise and nutrition.

Then when we get past those that only have one line of thinking, we can get down to those that care and offer sound advice and directions for taking care of ourselves. Even if I often do not like WebMD, they have done an excellent job of outlining the problems and treatment of wounds for people with diabetes.

The article has a ten point checklist that make a lot of sense.

Check you feet daily.
Pay attention to your skin.
Moisturize your feet.
Wear proper footwear
Inspect your shoes every day
Chose the right socks
Wash your feet daily
Smooth away calluses
Keep toenails clipped and even
Manage your diabetes

They put a lot under manage your diabetes – monitoring blood glucose levels, blood pressure, and cholesterol levels. At least they went on to say a person with diabetes should eat healthy, exercise regularly, taking medications the doctor prescribed, not smoking, and having regular medical checkups. Too many writers stop at just manage your diabetes.

I also like that WebMD also covers burns as part of taking care of yourself. There are many parts to wound care and burns can certainly happen. Please read this carefully even if it is not all about your feet.

Two other sites worth reading are: Site 1 and Site 2.

Please take the extra time to inspect your feet and legs daily and treat every minor injury immediately. This could save a toe, a foot, and even your leg by taking care of minor bruise, cut, or ingrown toenail early. If the healing does not start promptly, get to the doctor for quick medical care. This should be done for good care and proper antibiotics or other treatments.
You should have regular appointments with a podiatrist to check your feet to prevent problems from starting.  Even for regular food care this should be done.  For injuries see your regular doctor promptly.

October 19, 2010

Sleep apnea and hospitalization Part 2

This part provides some issues you need to be aware of for treatment of sleep apnea in a hospital or out-patient setting whether for a surgical or other treatment. This is information I wished I have made myself aware of for past procedures. I will be ready for any future procedures.

Oral appliance users will need to consult with their prescriber for procedures to follow, but much of the following may apply. Just substitute oral appliance when CPAP is discussed.

When using the term CPAP it will be in the generic sense meaning all types of Positive Airway Pressure devices for the treatment of sleep apnea, including CPAP, bi-level PAP, variable PAP, and auto-titrating PAP devices. When reading about obstructive sleep apnea (OSA) please use the terms mild or moderate sleep apnea if applicable.

For all sleep apnea patients, knowledge is important to get proper care and treatment in the hospital or out-patient area. If at all possible - DO NOT LEAVE YOUR EQUIPMENT AT HOME. This is important in so many ways as sleep apnea therapy is as important in the hospital as it is at home.

If you do not inform your physicians or surgeon of your need for sleep apnea therapy
during and after medical procedures, this can create problems in healing and delay recovery time leading to longer hospital stays. Do not assume that the physicians and nurses will know how to manage your OSA. If they are not aware, they will not be prepared to care for OSA.

Please ask if you may use your own CPAP equipment. This will be when you will find out what the hospital policy says and you should talk to your doctor as well as your surgeon and the anesthesiologist if you are having surgery to confirm the hospital's policy. If they say no, then ask if they have a form called “Permission and Release for use of Outside Medical Equipment/Appliance for Patient Treatment” so that you may use your own equipment. At this time also ask if they will need a letter from your doctor or a consultation with your sleep doctor.

The only way you should accept the hospital's equipment is if clear that it has the same or better benefits as you equipment. If they cannot meet these requirements, you should be able to use your own equipment for your own well being and comfort. Always make every attempt to use your own mask to control leaks and for comfort.

If they allow your equipment, ask if they need to inspect the equipment to see that it is functioning correctly and does not pose any hazards. Ask when they want to inspect the equipment as you do not want to do this too far in advance.

Important - Label your equipment, CPAP carrying case, mask, and CPAP machine. When you are admitted, labels identifying you, and for your chart are printed. Be sure to ask for enough extras to label your equipment.

Again important, if supplemental oxygen is required, your mask may have ports for attaching an oxygen line. If your mask does not have oxygen ports, contact you equipment provider or the manufacturer to find out if an oxygen port adapter is available for your mask. Most of the time the hospital may have an adapter that will work with your mask.

If you are having surgery and will have a breathing tube inserted into your windpipe, your CPAP will not be required. After the tube is removed, you should be put on the CPAP machine. If you are not intubated, then remind the hospital staff that the CPAP need to be used.

Show your family and/or friends who will be visiting as well as the doctor and shift nurses how to use your equipment. Let them know and reinforce with them that if you are sedated or sleeping, your CPAP needs to be operating.

Normally while you are in what is termed pre-operation stage and being prepared by the nurse, your surgeon and anesthesiologist will stop by to discuss concerns and surgical plans. Do not forget to remind them that your CPAP needs to be in use at all times (if not intubated), and that they need to check your oxygen saturation and to monitor your heart rate.

Be ready if there are exceptions to any of the above when applied to your upper airway surgical procedures and if this should be cleared with the treating physicians and discussed with your sleep physician.

Good luck.