Archive for September, 2010

Infection: Don’t Take It Lightly

Until I had the incident with an infection and saw how concerned my doctor was, I really didn’t realize the effects it could have. Foot ulcers in the diabetic is problematic. It is easy to injur the foot and not know it. Years ago, my husband and I went to Las Vegas. I was wearing socks and sandals on my feet. I was not a diabetic at the time. It was a very hot day. We walked a long distance taking in the sights, malls and casinos, then worked our way back to the RV Park where we were staying. I looked down at my feet as I stepped up into the RV only to discover my bloody feet. I had worn blisters on them. They had broken and bled. I should have gone to a doctor, but didn’t as we were in a strange place and didn’t know any one. We used a home remedy for over a week. I stayed off of my feet and took really good care of them. They healed and I didn’t get an infection. I think back now and believe I had the neuropathy then. Unfortunately, many don’t check their feet. They may even believe the ulcer or wound will heal on its own. It may be under a callus and become infected. Infection compounds the problem.

What is infection? It is a bacterial invasion that under favorable conditions multiplies and produces injurious effects. P7160109

What does it look like? (Symptoms) It could be sore, red, warm, or tender to the touch, swollen, and could even weep with a fluid, or pus. These could be ulcers and could turn into calluses anywhere on the bottom, side or toes of the foot. If ignored and nothing done to heal these, amputation could be the end result.

Where should I look for infection? Infection can be anywhere on the body, but with Charcot Foot one should be most concerned with the feet. Examine your feet often. Check for wounds, blisters, bruise and cuts. If the heels are cracked or areas are showing evidence of increased pressure, one needs to moisturize the skin and possibly be fitted for orthotics by a professional to cushion the foot.

Is infection easily missed? If one has Nueropathy some of the symptoms will no be evident. We have the tendency to think it will just go away, or heal on its own. One needs to check the area often, both morning and night. If it is not healed in a couple of days, one should seek medical attention.

Since MRSA has become a very serious concern, I would like to share this poster which was on display at the hospital.P6120074

What You Don’t Want: An Infection

#4 Set copyAbout a week had gone by and I noticed the incision on the leg where the muscle had been slipped was a little red. My next appointment was July 10th only a few days away. Unfortunately, when we went in I learned I had an infection in both the surgical incisions. These still had stitches. He removed the staple from my ankle and left the stitches on the leg and ankle. Then scraped both areas that were red and infected. We were all disappointed and weren’t sure what caused the problem. Maybe because it looked so good earlier we were in too big of a hurry.

Again my leg was wrapped like a cast and sent home for bed rest. I could wear the boot or surgical shoe. The surgical shoe was best as the boot was too tight and hurt the foot. For the first time I had to take an antibiotic once a day. Because of this, I had to be back on Wednesday as infections are serious.P7160111

Dr. Roukis Fitting ShoeJuly 16th Dr. Roukis scrapped the infected section on the leg, purposely making it bleed. He cleaned and packed it in such a way that the infection would heal. he was very meticulous.

He said it looked good and we were to repeat what we had done last week. We had another

appointment July 24th and things were progressing well. He removed the scabs with a scalpel and not a drop of blood. His skill never cease to amaze me. Then we learned he was going to be out of the country for a couple of weeks.Max rewrapping
He wrapped my leg and put me back in the surgical shoe.He gave Max the instructions for care and wrapping. Things went well. The entire process was about six weeks and I was back to walking quite normally with caution. Infections are scary and shouldn’t be taken lightly as many amputations take place because of them.

The Confession and Surgery Follow up

Set #1
Set #2(June 16, 2008) Three days had past since surgery and now I have to tell Dr. Roukis about my fall the night after surgery. Not sure I was lucky, or not as his assistant came in to prepare my foot. I told her what had happened. Of course she relayed the message to him. They unwrapped my foot and leg, removed the betadine strips and washed my foot and leg generously with the surgical scrub. I had 14 staples and 4 or 5 stitches. Everything looked really good.

When Dr. Roukis came in, it was obvious he was very disappointed in me even though he said very little. He sent me for x-rays.

Because of my fall, Dr. Roukis decided to put me into a cast even though the x-rays came back okay, no damage. I was surprised when he decided to do the cast himself. He rounded the bottom of the cast, making it nearly impossible to stand or walk on. I wasn’t to put any weight on the cast.#5 Set copy

June 26th back at MAMC. The cast was removed. Everything looked good. In fact so good Dr. Roukis removed most of the staples and stitches. He put bandaids on the stitched areas. He let me go back into my shoes. I was really nervous about this. He also said we could bathe the area and wear my compression socks. We were to care for it ourselves. I was really uneasy about this since it was such a short time since surgery.

Surgery On My Left Foot

My left foot was in stage one of Charcot. My toes were becoming hammer toes and the Achilles’ tendon was not very flexible. My ankle and foot were exhibiting some of the same problems my right foot and ankle did. In that, they felt like they were not wanting to stay together.

Maybe I shouldn’t have been surprised, but I was, when Dr. Roukis said he would perform surgery on my left foot the next summer. I guess I didn’t think I needed it. After all I was not having major pain in that foot. Surgery made a lot of sense though. It did mean recovery time, but only about six weeks compared to years. It would also be an out patient surgery so no hospital stay. This is why it is so important to get this diagnosis in the early stages.

Surgery was June 13, 2008. Of course I went through all the physical and permission stuff. We arrived at MAMC at 5:50 AM, checked in and was sent to the area to prepare for surgery. Max took my shoes and clothes as I would be in the surgical gown. My anesthesiologist was excellent. I had no bruises. There was only a small entry point between my thumb and pointer finger. I also asked him if I could be awake when I went into the operating room as I was out for the other two surgeries. He said sure. He kept his promise. I was surprised at how large the room was and that there were so many people there. I’m sure some were Dr. Roukis’ students. As soon as they began to swab my toes, I was out like a light.Before my left foot operation

One rather funny thing happened while waiting to go into surgery though I’m not sure Dr. Roukis thought it was. He came rushing in to the waiting area right past us. Stopped quickly, backing up. Greeted me and introduced himself to my anesthesiologist. Then he asked him, “What operating room are we in?” He replied “A.” Dr. Roukis said “They told me C. When I went in there , looked around and said, “I don’t do this type of surgery” and left. ”

We discussed the type of anesthesia so I asked Dr. Roukis what he wanted for me. Apparently I could have had a spinal, but we decided completely out. (I really don’t think he wanted me to be able to talk.)

Recovery after surgery was very quick. No sore throat, so was able to dress, get in the wheel chair and to the van, back seat and packed in. This was quite awkward as I couldn’t use the foot I had depended on for so long and I wasn’t sure of the right one. We were back home by 11 AM. I slept most of the way home. All went well until about 2:30 AM. I thought I could get up on my own. I knew I should wake Max and have him help me, but he was sleeping so soundly. (Not for long) As I tried to slide my feet to the potty, my shoe caught in the carpet and I fell. I tried to save my feet, so my knees hit the walker and I hit the right side of my head when I hit the floor.

After the operationIt took a while to gain my senses so I could roll, crawl and get up enough to sit on the small stool Max was holding so I could stand as I couldn’t put weight on the left foot. Need I say I asked for help after this. Was I afraid to tell Dr. R about this? Oh, Yes!

During surgery Dr. R straightened my hammer toes, lengthened the achilles tendon by slipping the calf muscle and placed a pin in my ankle like my right foot. They sent pain medication home with me and I only used a couple of the pills. One after the fall and another the next evening to help me sleep. That didn’t work. I didn’t take any more again I really didn’t have any pain.

Now I have to tell DR. Roukis about my fall three days after surgery.

The Next Step: Custom Shoes

Foot covering is always a concern. Since I was now able to walk, it was necesary to have footwear that would protect my feet and be comfortable. The thought of being able to wear shoes again was exciting.

Since there would be a year between the surgeries on my feet, it was decided custom shoes would work well for me before the left foot surgery. I had an appointment with orthotics where the casting would be done for both feet. The process took nearly an hour.

Fitting #1Pat cut a length of “tube” sock, putting it over my foot and lower leg. Next a plastic bag, a stay, like the tongue of a shoe, and another length of “tube” sock over that. She had my foot over a Styrofoam block. Next came a fiberglass sock dipped in water and slipped over my covered foot. My foot was pressed into the foam, The fiberglass massaged and shaped to my foot exactly. Once set, it was warm. Pat then marked it and cut over the stay so it was like a shoe. I was able to slide my foot out of the “fiber glass shoe”. These forms were then sent to the shoe company to be measured in the inside with a laser. A leather shoe was made and an orthotic placed inside specifically for each foot.Fitting #2

I was never really satisfied with these shoes. I was accused of not liking them because they weren’t pretty, or fashionable. I never felt they were comfortable nor did they fit right. I think by the time I finally got the shoes much of the last swelling had gone down in my right foot and the fit was no longer correct. I couldn’t get this communicated so ended up wearing them and limping. I also found my feet sweat a lot. This concerned me, but no solution was found. I needed to use the walker as I seemed to tire a lot. I also tried to use a cane, but I couldn’t adjust to using it with my left hand. I never felt like I was stable.Fitting #3

Max’s observation was that when I walked the outside of my right foot seemed to touch the walking surface first. then flatten out. Fortunately, I didn’t have to wear these shoes very long. I would like to add however, if these shoes had been a good fit they would have been excellent shoes for someone with foot problems and needed to protect the feet..Untitled-1