Dear patient (Sorry I didn't see your name on the query),

According to your information, you are a known diabetic on oral drugs with controlled sugar levels.

Now the description of your leg looks like two mixed problems:
1. It is swollen and doctor is giving you acitrom tablets... it implies he is expecting it to be XXXXXXX vein thrombosis which means blood clotting in the veins.
2. As you are diabetic and with age of 59 years, you are expected to have some arterial blockage also. And the wound with discharge can be attributed to this lesion.

I would like to know a few things for proper diagnosis:
1. Is there any blackening on any part of leg with foul smell?
2. Where exactly the wound is located? Is it on foot / sole / toes?
3. Are you a smoker or hypertensive (high BP patient)?
4. Have you got any scan for your leg? I mean arterial or venous Doppler / duplex scan? And if yes, can you provide me the report (you may use the website's uploader to load the reports)? If not then you should contact either vascular surgeon or radiologist and get the scan done.

Your medicines look right to me. But without diagnosis there is no meaning in taking augmentin or acitrom. So let’s first get the diagnosis and then proceed further.

Meanwhile you can elevate your legs for night and whenever possible in day - that will definitely relieve your swelling and help in healing also.

But your non healing wound needs two most important things - controlled blood sugar and duplex scan to know your blood circulation. A blocked circulation may need either medicines or angioplasty or any surgical treatment.

Take care of your wound. It should not get infected. Keep it clean until proper treatment.

I hope I have solved your queries and guided you properly. Please feel free to ask any further queries and I’ll definitely try to solve your problem.

Regards,
Srujal shah
Vascular surgeon
Ahmedabad

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Hi Mr. AAAA

Now with the details you provided, it clinches the diagnosis towards "post thrombotic syndrome" or "venous ulcer". In normal language, once you develop DVT, many of our leg vein valves may be damaged and it can lead to varicose veins of legs.

There may be some perforator vein incompetency (leak) which can lead to increased vein pressure in that particular area, in your case XXXXXXX where you have the ulcer and discharge. Detailed examination and venous duplex scan can establish the diagnosis surely.

Anyways, as you said, swelling had reduced to 75%, I would suggest you continue compression therapy. Bandages are ok but if you can wear compression stockings (special tight stockings), they will give proper pressure and allow early healing. Put a dressing on your ulcer and then wear stockings for daytime. They should be grade 2 compression at least knee length. Various companies like sigvaris and medi are famous and provide good quality Stockings. Bandages do not provide adequate and equal pressure, which is necessary for venous ulcer healing.

All this is true for venous ulcer management. As you said there is no blackening or bad smell, arterial ulcer is less likely, but still if you have any doubts, please contact vascular surgeon in Bangalore. XXXXXXX institute of vascular surgery is in fact a good place if you do not get relieved.

One more thing, keep 2 pillows below your heel and lower leg to elevate them during night time when you are not wearing stockings.

It may take 1 month also to heal the ulcer. So be patient.

Please let me know if you have any other doubts. In addition, I can reply for them.

I hope I have solved your queries and your lesion heals soon.

Bye.
Regards,
Dr Srujal shah

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