Update on Those with Foot Problems

We now have seen all four that have serious foot problems. All four are off the SGLT2 Inhibitors, thankfully. They are now using insulin and doing much better.

The fellow with the infected cracked heel did have the start of gangrene, but the doctor operated and removed it. It will take several months for this to heal and he is on crutches for several months so that he can keep his weight off it. The doctor said the chances of success were good and it is now up to him to treat it and keep his appointments for the doctor to examine it weekly for at least two months. At that time, the doctor will reevaluate it and see him every two weeks and then possibly monthly.

When we had our meeting with them, all were thankful we had forced the issue and taken them directly to the emergency room. The fellow that had two foot ulcers is also using crutches and said he will be seeing his doctor every week for possibly two months and then the doctor will reevaluate and possibly change the frequency of checkups.

The other two are also using crutches and are also seeing their doctor every week for a month and then they will be reevaluated for longer times between appointments. Max and Barry were very happy that with how serious they had looked and now having them being able to get around with crutches, that the most serious threats were behind them. Jerry said that the fellow that thought he had LADA really had type 2 diabetes and the hospital confirmed this with the correct tests. He decided to stay on insulin because of the level of management he is achieving.

The five profusely thanked us and said they had learned a lot in the last week and now know how important caring for their feet is. Two said they will be adding a podiatrist to their diabetes team and the other three said they were changing doctors that would check their feet on a regular basis. All are planning to remain on insulin and three have submitted their papers to be seeing the Veteran Affairs doctors yet this year.

All five want to join our support group and we will recommend them at our new member meeting in October. We have decided as a support group to add members in the month of October and plan our meeting accordingly. Tim said he would schedule accordingly and have one or both nutritionists and our CDE available to do a presentation and answer questions.

We are discussing in groups and by email the idea of assessing dues in the amount of $15 split into three months. Many are in favor, but a few are against dues. This will be the subject for our September meeting and this is why we are talking about this now to find out where the opposition is and their reasons. Most of us feel the dues should go to speakers, but others have other ideas. Several of us feel we will lose some members if we have dues, but now we are discussing if this will be a good or bad thing.

The potential new members feel that the dues are reasonable and they feel we have earned it and that paying for speakers would be a good thing. Tim said that at present, all but one of the potential new members favor having dues.

Tim said that many of those opposing $15 dues would accept $10 dues and this is being discussed also.

More with the Diabetes Goals

In the gathering we had in the last blog, we finally got to what medication each was taking and we were shocked that only one person was on insulin because his doctor believed that he had LADA diabetes. The rest were all on Invokana or Farxiga and metformin. Ben spoke and asked how they were doing on these medications. The fellow on insulin stated that he was doing very well and that his last A1c was 5.8 percent.

The one on Invokana asked if someone would look at the bottom of one foot. When Tim said okay, he took off his shoe and sock. When Jerry looked, he said he should see a doctor immediately and even go to the emergency room that day as he had the start of a nasty foot ulcer and possibly a second one. One of the fellows on Farxiga asked if he could look and then said he had two that were worse than that. Jerry had him remove his shoe and sock and when he saw both ulcers, he said we needed to take him immediately.

Another said he had a cracked heel and Tim asked him to remove his shoe and sock. Tim said he needs to go to the hospital as well as he had an infection in his heel and gangrene may have already started. I asked all of them if the doctor had ever checked their feet and the answer from all was no. Tim then asked if all would take off their shoes and socks and let us inspect their feet. There was no hesitation and what we discovered had us very concerned.

Tim asked if he could have all of their email addresses and there was one question of why. Tim said so that we could send them emails about our experiences, articles on foot ulcers, and articles about the medications they were taking. In addition, each of us would receive their email address and our email addresses and if they would include their phone numbers, they would also receive our phone numbers. Everyone did give Tim the information and then Tim said that they would all need out support over the next few months because of the problems they were having.

Tim said that he hoped none of them would require an amputation, but in looking at a couple of them, he could not say what the doctor would want to do. This had two of the individuals very anxious and one asked not to be taken to the hospital. Jerry said he should go and if we had caught it early enough, then he could just spend several months in treatment. If he waited, an amputation would be required.

Tim said he had one of my blogs that he would send to each of them and he would need to find the article on the SGLT2 Inhibitors causing amputations, as I had not written about this.

With that, we loaded the fellows on two vans and headed for the emergency department to have the doctor on duty look at their feet and legs. Two individuals were hospitalized after being operated on and two others were admitted for further treatment the next day. Only one was treated and released with Jerry saying that for the first few days, he would change his coverings and applying the medicine.

All four were taken off their SGLT2 Inhibitors and put on insulin while in the hospital. What else happened, we don't know at this time, but we feel better in helping these individuals.

Our Second January Meeting and a Surprise

As soon as Tim said we would have our second meeting this month, Brenda and Jason have been busy, and both Brenda and Sue have been in contact with me about images to use. I pulled up several images like the ones below and emailed them to both.

 

Brenda said she was forwarding both to Tim and she said the top picture was close to the one she saw. She was not sure she could get the name of the antibiotics used, but she knew the place where the member received her prescriptions and maybe the member would let her see them.

When the date arrived, January 24, we were ready. Only one member was absent and that was the one that Sue was working with to heal the foot ulcer. Sue said the doctor had ordered her to stay off her feet for a week or more and she did have crutches. Tim called the meeting to order and stated that we have told you we are interested in helping each and every one of you and for you to ask questions. He said we have one member absent because of a foot ulcer and another person that is here while still recovering from a cracked heel. The doctor has also ordered her on crutches. So before we start this evening, everyone sit down, take off your shoes and socks or stockings, and have your feet ready for inspection.

There was a lot of grumbling, but everyone complied. Allen brought out the two stools for the people to rest their feet on during the inspections. Tim had not told us he had two podiatrists coming, and he went to the door and invited them in. Tim introduced them and said he had arranged for everyone to obtain a free foot inspection. The one podiatrist that knew me came to me first while the other went to Allen first. When they had finished with us they explained what they had seen and the podiatrist that examined me asked me to sit on the rolling stool and pushed me around the group to show them the big toe that he knew about and he announced that it had not changed much since he had last seen me. He did say that the damage was under the toenail and not the toenail as he had originally thought as the toenail was growing. He said I had notified him at my last checkup and he would keep watching it. With that he asked me to notify his office if there were more changes, but for now he was not concerned. He asked me to put my socks and shoes back on and assist him.

The podiatrist that had examined Allen said he found nothing and that Allen's feet were in good condition and to get ready to help him. With that we moved the stools while the doctor took the chairs they would use. They checked the older members first and found nothing other than one scratch on Rob's ankle which Rob said he was using Neosporin on it before bed each evening. The podiatrist said it looked like it was healing. Next they started with the member with the cracked heel and the podiatrist said it was healing well and if she continued to follow the treatments she should be okay in another two or three weeks.

Next, my podiatrist examined Jerry and said that the foot ulcer was healing nicely and as long as he continued the treatment the doctor has prescribed, it should be okay in another month. Jerry said that was what the doctor had told him. We continued with the rest of the new members and found two more members with minor cracked heels and another member with the start of a foot ulcer.  One in-grown toenail was also found. They were advised to see their doctor as quickly as possible or to make an appointment with one of them the following week. The three were told if they wanted prescriptions to help them start the healing, they would be given one.

Tim said that this evening was done for their benefit and the rest of the members wanted what was best for them. But with the problems happening the prior two weeks, this was what brought this meeting about. Then he asked if anyone did not have insurance. When no hands were raised, he asked why people were not taking care of their health. He apologized to the doctors for interrupting and asked them to finish their talk about proper shoes.

The doctors said most of the cracked heels were probably caused by wearing the incorrect shoes or foot support around the house or apartment. During the winter, wearing shoes without proper heel protection helps aggravate dry and cracked heels, and he was not talking about high or spike heels for women. If they wanted to wear elevated heels with proper foot support, those could work.

For the foot ulcers, they strongly recommended wearing foot support in the shoes and these needed to be custom fit by a specialist and they could give them at least three that the person could chose from. They had seen the supports that Max had and asked him. Max gave the name and they agreed that the person was good. Jerry asked how soon he should consider getting fit for them and they said not until the ulcer had healed, but that he could get one for the other foot anytime.

Tim asked if anyone else had any questions and there were a lot of questions from the newer members and a few from the older members. In the meantime he told Brenda and Jason that he had taken over the program when he got acceptance from the two podiatrists as he felt that this was best. Brenda and Jason agreed that this was more effective and had been well received. Tim thanked them and said he would not do this again without notification, but he had only received confirmation about an hour before the meeting.

I went to thank the podiatrists and they admitted they had hesitated, but after seeing the number and the interest, they admitted that it was worth the trip. I commented that they should pick up a few patients as well. They both agreed and Tim said the meeting is over. About another half hour was spent with many asking questions and then the two doctors needed to leave. Many of the members said thank you to us as they left.