Suggest Treatment For Unhealed Wound On Toe In A Diabetic

Posted on Thu, 27 Aug 2015

Question: My Father is 65 years (born in 1950). He is suffering from diabetes for past 20 years. He also undergone CABG at Wockhardt, in the year 2009.
Recently, there was a small wound in the right toe. Doctor at local hospital treated the wound for about 2 months. When it did not get healed, he was referred to vascular surgeon. Vascular surgeon, performed peripheral angiogram, and confirm that the blood flow is fine. After treating for a week, when the infection was not getting controlled, the doctor suggested to amputate the toe and it was done 2 weeks back. Since his diabetes is not under control, Diabetes doctor suggested Insulin R 20 units (morning, noon and evening) and Lantus 10 units (at bed time). Now, my father is on below medications
Morning : clopivas - 75mg, stiloz 100mg, Arkamin 10, Dytor 10
Noon : Storvas 10mg
Night : Aten 100, Arkamin 10, Dytor 10, minipress xl 5mg, stiloz 100mg,

augmentin 375 mg is prescribed antibiotic.

Now, after having good, my father has a vomiting sensation.
Recently, from past 2 weeks he is suffering from sever chill at the back. Checked with different doctors, but none of them has a right or satisfactory answer. keenly awaiting for your inputs.

Answered by Dr. Riyanka Chail (2 hours later)

Brief Answer:
Please consult the doctor for proton pump inhibitors and calcitriol sachets

Detailed Answer:
Hello Mr. XXXX,

Thanks for writing in to HCM.
This is Dr.Riyanka Chail answering your query.

I understand the concern regarding your father. Since hes a known diabetic , giving him stronger antibiotics is very essential.

However since he is taking so many medications it can cause gastric irritability that can cause vomiting sensation.

Kindly consult your doctor for medications like :
1. Tablet Pantoprazole 40mg(proton pump inhibitor) half an hour before breakfast daily one tablet for atleast 4 weeks. After that he can continue to have it at a strength of 20 mg for atleast 2 months.

Also, kindly ask the doctor regarding Calcitriol (vitamin D3) sachets containing 10,000IU strength .
This shall reduce pain at the back and is recommended for heart patients.

Rest of the cholesterol lowering, sugar lowering and blood thinning medications are correct and should be continued.

Hope this answered your query.
Kindly write back for more doubts.

If your query has been answered please close the window and rate the answer.

Regards,
Dr.Riyanka Chail, MBBS, MD

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Riyanka Chail (14 hours later)

Thanks Riyanka. Consulted doctor and he has prescribed Rablet-D, before meals. Right now, we are taking this 3 times a day before meals. Please suggest the dosage.

Also, my father experiences Sever chill at the back (just below the neck), specially during the night (around 8-9). Some times in the evening. What could be the cause for this?

Answered by Dr. Riyanka Chail (2 hours later)

Brief Answer:
Rablet D - Rabeprazole 30 mg/Domperidone 20mg

Detailed Answer:
Hello,

Thanks for writing in to HCM with updates.

Rablet D consists of Rabeprazole 30 mg(proton pump inhibitor) and Domperidone 20mg (anti vomiting). He can take this every morning atleast half an hour before breakfast empty stomach till he is having the antibiotics.

Later after the antibiotic course gets over he can take Tablet Pantoprazole 20 mg (proton pump inhibitor) this every morning atleast half an hour before breakfast empty stomach for two months to avoid gastritis (after consulting his cardiologist).
About the chills at night at the back it could be due to spinal problems due to old age (bone erosion) .
You could consult an orthopaedician who would recommend an Xray of the spine to rule out osteoporotic changes due to old age if it is there. Also he/she may advise for medications like calcitriol (vitamin D3) and biphosphonates (help in preventing loss of bone mass).

Hope this answered your query.
Kindly write back for more doubts.

If your query has been answered please close the window and rate the answer.

Regards,
Dr.Riyanka Chail, MBBS, MD

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Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar