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What Causes Changes In Skin Texture In An Elderly Person With Diabetics And Hypertension?
Question: I need your advise on what can I do to help my mother.
My mother is a 62 year old type 1 diabetic with high blood pressure and circulatory problems. I am concerned about her health because she has a big varicose vain protruding from her left leg, her skin looks like a thin layer of plastic and now to make matters worst she has a hole in her right leg. Attached I a sending a picture of the hole, the picture was taken on October 31, 2015, at that time she already had over a month with the hole on the leg, it started very small and it was getting bigger and bigger, but on that picture it was looking better. Now is getting bad again and I fear that if we don't find the way to heal it, she will get worst. She's scare to go to her regular doctor, because he mentioned that she might have to get the leg cut off!
I am terrified because in my mother's family we already have lost two relatives after the amputation. My mother lost one of her oldest sisters in 2008 days after one of her legs was cut off because she got gangrene, then in 2010 a niece (daughter of the sister that died on 2008) had both legs amputated, she lived over a year after the amputation and died of complications related to dialysis.
She's having memory problems and her vision is poor.
Please help me, I need to save my mother's legs and her life.
My mother is a 62 year old type 1 diabetic with high blood pressure and circulatory problems. I am concerned about her health because she has a big varicose vain protruding from her left leg, her skin looks like a thin layer of plastic and now to make matters worst she has a hole in her right leg. Attached I a sending a picture of the hole, the picture was taken on October 31, 2015, at that time she already had over a month with the hole on the leg, it started very small and it was getting bigger and bigger, but on that picture it was looking better. Now is getting bad again and I fear that if we don't find the way to heal it, she will get worst. She's scare to go to her regular doctor, because he mentioned that she might have to get the leg cut off!
I am terrified because in my mother's family we already have lost two relatives after the amputation. My mother lost one of her oldest sisters in 2008 days after one of her legs was cut off because she got gangrene, then in 2010 a niece (daughter of the sister that died on 2008) had both legs amputated, she lived over a year after the amputation and died of complications related to dialysis.
She's having memory problems and her vision is poor.
Please help me, I need to save my mother's legs and her life.
Brief Answer:
Sure. We will do our best.
Detailed Answer:
Hello,
Thanks for writing to HCM. Noted your query.
As I can see your mother is a long standing diabetic with high blood pressure and varicose veins with a diabetic lower limb ulcer that's been there since around 4 months. She sure memory issues and vision related problems and also has a significant family history of diabetic foot ulcer needing amputation.
I understand how concerned you are. Don't worry. We will tackle it as best as we can.
To begin with a patient with such long standing ulcer is prone to have peripheral vascular disease (decreased arterial circulation to the legs). Your mother needs to get her peripheral pulses examined and also do a arterial doppler + ankle brachial index. That will help us understand if she has enough circulation to the legs. For any wound to heal the most important thing is adequate blood circulation.
Secondly, as she has varicose veins in the other limb its highly probable she has it on the affected one too. So she needs an examination along with a venous doppler to assess its significance. Varicose veins simply means that the blood without oxygen gets pooled in the legs. You can quite imagine how adversely that will affect wound healing. So if she has a bit of arterial and venous issues it will only complicate the issue.
So let is begin with getting her leg examined for arterial and venous flow.
Thirdly, any wound that needs to heal should be offloaded which means the weight of the body should not be borne by the affected leg. Its extremely important if the wound is in the feet but its important to an extent if its in the leg also as walking contributes to swelling leading to relative decrease in blood flow to the area.
Fourthly, the picture you send doesn't look grossly infected. I do not know what the current status is. Any chronic wound should be suspected for infection and a tissue culture should be taken. Based on the tissue culture we can give her culture specific antibiotics targetting the organism rightly.
And lastly, she needs strict sugar control. Diabetes itself is an immuno comprimised state which means the body doesnt defend itself well against germs. If the sugars are high its impaired further. It takes about 3 weeks of perfect sugar control after which the body's defenses deals with the organisms strongly.
Your mother needs all these to be done. Postponing a doctors visit is not the right thing to do. Do not fear of amputations. Limb salvage has come a long way and no surgeon would think of that unless all options have been tried. An amputation is indicated if the wound leads to any life threatening state. Presently i believe she is stable and we need to use this time to fix the problem rather than wait until it gets worse at which point the chances of amputations are very high.
So to summarise, good sugar control + offloading + antibiotics + attentions to blood flow (arterial and venous) will heal 90% of the wounds. I believe your mother can be in that and she need not have to face the decision your aunt and neice had to.
I will be glad to advise if any more doubts arise. Wishing her good health. Don't worry. I strongly feel this can be fixed.
Warm regards.
Dr Praveen
Sure. We will do our best.
Detailed Answer:
Hello,
Thanks for writing to HCM. Noted your query.
As I can see your mother is a long standing diabetic with high blood pressure and varicose veins with a diabetic lower limb ulcer that's been there since around 4 months. She sure memory issues and vision related problems and also has a significant family history of diabetic foot ulcer needing amputation.
I understand how concerned you are. Don't worry. We will tackle it as best as we can.
To begin with a patient with such long standing ulcer is prone to have peripheral vascular disease (decreased arterial circulation to the legs). Your mother needs to get her peripheral pulses examined and also do a arterial doppler + ankle brachial index. That will help us understand if she has enough circulation to the legs. For any wound to heal the most important thing is adequate blood circulation.
Secondly, as she has varicose veins in the other limb its highly probable she has it on the affected one too. So she needs an examination along with a venous doppler to assess its significance. Varicose veins simply means that the blood without oxygen gets pooled in the legs. You can quite imagine how adversely that will affect wound healing. So if she has a bit of arterial and venous issues it will only complicate the issue.
So let is begin with getting her leg examined for arterial and venous flow.
Thirdly, any wound that needs to heal should be offloaded which means the weight of the body should not be borne by the affected leg. Its extremely important if the wound is in the feet but its important to an extent if its in the leg also as walking contributes to swelling leading to relative decrease in blood flow to the area.
Fourthly, the picture you send doesn't look grossly infected. I do not know what the current status is. Any chronic wound should be suspected for infection and a tissue culture should be taken. Based on the tissue culture we can give her culture specific antibiotics targetting the organism rightly.
And lastly, she needs strict sugar control. Diabetes itself is an immuno comprimised state which means the body doesnt defend itself well against germs. If the sugars are high its impaired further. It takes about 3 weeks of perfect sugar control after which the body's defenses deals with the organisms strongly.
Your mother needs all these to be done. Postponing a doctors visit is not the right thing to do. Do not fear of amputations. Limb salvage has come a long way and no surgeon would think of that unless all options have been tried. An amputation is indicated if the wound leads to any life threatening state. Presently i believe she is stable and we need to use this time to fix the problem rather than wait until it gets worse at which point the chances of amputations are very high.
So to summarise, good sugar control + offloading + antibiotics + attentions to blood flow (arterial and venous) will heal 90% of the wounds. I believe your mother can be in that and she need not have to face the decision your aunt and neice had to.
I will be glad to advise if any more doubts arise. Wishing her good health. Don't worry. I strongly feel this can be fixed.
Warm regards.
Dr Praveen
Above answer was peer-reviewed by :
Dr. Sonia Raina
Thank you so much Doctor XXXXXXX I will try to send you another picture of her leg tomorrow and I will let her know that controlling her sugar intake and I will convince her to follow your advises.
Once again thank you!
Regards,
Ada
Once again thank you!
Regards,
Ada
Brief Answer:
You are welcome
Detailed Answer:
Hello again Ada,
You are welcome. I will review the new picture and get back. Let us remain positive about the outcome.
Regards
Dr Praveen
You are welcome
Detailed Answer:
Hello again Ada,
You are welcome. I will review the new picture and get back. Let us remain positive about the outcome.
Regards
Dr Praveen
Above answer was peer-reviewed by :
Dr. Sonia Raina
Good day Doctor XXXXXXX
Sorry for the delay to send you the pictures.
My mother started going to the beach hoping to get her wound better with the sea water. She went two days in a raw and these pictures were taken on Wednesday night.
She lives in Dominican Republic so the weather there is an eternal summer. She was advised by her doctor to use compression ccl socks, but with the high temperature in the Dominican Republic the socks may keep the area too hot.
Now she's spending more time relaxing with her legs resting on an ottoman, my mother hates to lay down in bed, so she continue taking care of the house, go to rest for a while and return to the same busy bee lifestyle taking care of every aspect of keeping her home clean. She has an obsession with keeping her home spotless.
Sorry for the delay to send you the pictures.
My mother started going to the beach hoping to get her wound better with the sea water. She went two days in a raw and these pictures were taken on Wednesday night.
She lives in Dominican Republic so the weather there is an eternal summer. She was advised by her doctor to use compression ccl socks, but with the high temperature in the Dominican Republic the socks may keep the area too hot.
Now she's spending more time relaxing with her legs resting on an ottoman, my mother hates to lay down in bed, so she continue taking care of the house, go to rest for a while and return to the same busy bee lifestyle taking care of every aspect of keeping her home clean. She has an obsession with keeping her home spotless.
Brief Answer:
Close observation needed
Detailed Answer:
Good day. Noted the contents. I had a look at the pictures. It needs close observation. Looks a little inflamed. Please discuss everything we discussed again with her. Ask her to take enough rest. Let us see how it goes. Compression stockings will be very useful. Wishing her good health. Warm regards.
Close observation needed
Detailed Answer:
Good day. Noted the contents. I had a look at the pictures. It needs close observation. Looks a little inflamed. Please discuss everything we discussed again with her. Ask her to take enough rest. Let us see how it goes. Compression stockings will be very useful. Wishing her good health. Warm regards.
Note: For further follow-up, discuss your blood glucose reports with our diabetologist. Click here.
Above answer was peer-reviewed by :
Dr. Raju A.T
Answered by
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