Brief Answer:
Unlikely to be bone cancer and delay in healing is due to diabetes

Detailed Answer:
Hi XXXX,
Thanks for writing in to us.

I have read through your query in detail.
Please find my observations below.

1. The surgical wound in patients with diabetes might require a longer time to heal completely. This is because the increased blood glucose levels delay wound healing and that is what has happened in your case.

2. There is no sign of bone cancer if the bones were normal before the surgery. I mean to say that no patient will develop bone cancer after ORIF and within 2 months.

3. You have to continue with slow weight bearing and application of the antibiotic ointment in the wound area.

4. You have not provided details and reports of the 3 chest CT scans. It is important to know why they were done and what are the findings. If CT scan chest is normal on all 3 occasions then probably there is no abnormal condition in the chest which can be causing you the discomfort starting at right shoulder and continuing downwards.

5. You can get another X ray of the ankle to know how the bone is healing 2 months after the surgery.

6. Please take precautions and avoid water entry and dust exposure to the wound so that it does not get infected.

7. You can follow a 1800 kcal diet and include fresh fruits and vegetable to give you required vitamins. Fresh fruits and vegetables are rich source of vitamins and minerals. Should you feel that your diet contains a lower amount of recommended daily allowances then taking vitamin supplements is suggested. Since you are diabetic therefore having a dietitian provide you with a diet chart is recommended.

Hope this answers your question. Please feel free to correct any oversight in my interpretation of your problems and discuss them in detail as per your requirements.

Hope your query is answered.
Do write back if you have any doubts.

Regards,
Dr.Vivek

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Brief Answer:
There is 99.81 percent chance that you will not get cancer due to this

Detailed Answer:
Hi XXXX,
Thanks for writing back with an update.

1. Th additional X ray dose which you received from 3 CT scans done for pulmonary embolism amounts to a radiation of approximately 45 mSv. The risk of a cancer (any cancer and not only bone cancer) is 0.19 percent.

2. In other words there is 99.81 percent chance that you will not develop any cancer risk because of this.

3. Since ankle surgery and immobilization due to having a cast itself can be stressful, it is possible that you might be having gastritis symptoms, unpleasant feelings and vague pains due to your anxiety and the delay in complete wound healing.

4. Once you stay relaxed and have your meals on time and continue with your rehab, the symptoms will improve and you will start feeling normal again. Tylenol must be taken only when required. You can also take prescription medicines for your gastritis after consulting your doctor.

5. The wound is healing but as you are aware that wound healing takes a while longer in diabetic patients. Also please protect any water entry and exposure to dust to prevent wound infection as discussed earlier.

Hope your query is answered.
Do write back if you have any doubts.

Regards,
Dr.Vivek

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Brief Answer:
Please find details below

Detailed Answer:
Hi XXXX,
Thanks for writing back with an update.

1. It appears that the actual wound inside has closed and the upper layers are healing as seen in the new picture you have attached. This detail was missing in earlier pictures.

2. Your doctor is right in giving you instructions. The soap and water is to prevent any dust from depositing on the healing wound.

3. Please wipe completely dry after washing with soap and water and then apply the cream covering the wound.

4. Amoxicillin is an antibiotic and given for preventive measure to avoid any infection.

5. The muscles and tendons are healing slowly and since you had a cast there will be some stiffness for a while.

Hope your query is answered.
Do write back if you have any doubts.

Regards,
Dr.Vivek

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Brief Answer:
Please attach Doppler report copy if available

Detailed Answer:
Hi XXXX,
Thanks for writing back with an update.

1. Do you have a copy of the Doppler report so that I can explain the finding in detail.

2. I am an expert in doing limb Doppler and wish to know what exactly they meant and at which location.

3. A clot in a superficial vein is not a serious concern.

Regards,
Dr.Vivek

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Brief Answer:
Please let me know when you have attached the report copy

Detailed Answer:
Hi XXXX,
Thanks for writing back with an update.

1. Thanks for the update. I will be awaiting your report. Please let me know by a follow up when you have attached the report.

Regards,
Dr.Vivek

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Brief Answer:
Its a small thrombus and expected to resolve by itself

Detailed Answer:
Hi XXXX,
Thanks for writing back with an update.

1. There is a small clot in a vein within the calf muscle and this usually resolves without any active treatment with anti coagulants.

2. However should you have increasing pain and swelling in the calf region with redness of skin then you should immediately talk to your doctor because it can indicate progression of the thrombus.

3. Please do light movements and exercises of the leg as suggested at the rehab.

Regards,
Dr.Vivek

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