March 6, 2022
The fifth installment of Marc's narrative describing how he manages his diabetes and health challenges.
In the first, introductory, installment of my blog, I included a then-current X-ray and picture of an open wound on my left foot. I expressed my intention to describe chronologically in subsequent installments the history and progression of my diabetes that led to the Charcot collapse of my foot and other limb-threatening complications, including the most recent one. In the second installment, I described the circumstances surrounding the onset of the disease. My intention was to describe in this installment the history of my failed effort to control the disease which set the stage for the complications that followed. However, given that most of my readers are already suffering severe foot complications, I have decided to interrupt the chronology of my struggle with diabetes in hopes that a description of the source and treatment of my current problem will be of more immediate value to others who are facing similar challenges.
For many of the readers of my blog who are suffering from the devastating complications of Charcot and other serious diabetic foot disorders – including foot collapse, reconstructive surgeries, amputation(s) and extended recoveries --- hearing about my year-long struggle and effort to heal from the consequences of an infected foot callous may appear insignificant. Having myself endured a Charcot collapse, two reconstructive surgeries, the wearing of an external fixator, a toe amputation, repeated infections and tens of months of non-weightbearing recovery periods over just the past ten years, I am well aware of the relative lesser impact of this problem on the quality of my life. I dwell on it not to garner undeserved sympathy but instead to reinforce the primary message of my blog: the importance of awareness,prevention, quality foot care and treatment options to minimize the consequences of this devastating disease for those who suffer from it.
As I explained in the last installment of my blog, I began treatment from a wound care specialist in March 2021 (eleven months ago) to help heal the remnants of a surgical incision resulting from the removal of an infected foot callous a few months earlier. Although many podiatrists provide such treatment, my experience had been that few possess the training, discipline and time to required to do it well. Fortunately, I live in an area with a wide range of high-quality medical care facilities and I was able to locate a highly experienced wound care specialist (“Marie”) in the orthopedic department of a major university medical center located near my home.
Marie is trained in the latest and most advanced methods for the treatment of diabetic wounds, including the use of technology, specialized dressings and grafts and orthotics. Unlike most podiatrists, Marie’s practice is limited to wound treatment, so she has the time and resources to devote to the intensive wound-healing process. (Marie is not only a skilled practitioner, but also one of the warmest individuals and most dedicated professionals I have ever known). I saw Marie once or twice per week, for an average of one hour per visit, for almost nine months. (Fortunately, the costs were fully covered by my Medicare insurance, an advantage regrettably not available to all my readers). I describe the highlights of treatment below.
Impaired circulation, immune deficiencies and nerve damage combine to make healing very difficult for diabetics. Marie used a variety of techniques to address these issues and improve healing. She employed three different advanced technologies at various stages in the treatment of my surgical wound. During each weekly visit, she used a low intensity laser and an electric stimulation device to stimulate tissue growth and improve blood flow to the wound bed. Both devices were non-invasive and painless and required a combined twenty minutes of treatment. About half-way through the course of treatment, Marie ordered a wound vac, to deal with problems we encountered in closing the wound. The wound vac is a portable device that operates like a mini-vacuum cleaner. A hose runs from the vacuum device to the foot where it is affixed to the wound bed with adhesive. The device slowly extracts the drainage from and helps reduce the size and depth of the wound. I used the wound vac around the clock for about three weeks and discontinued it when the drainage stopped.
During the healing process, the skin surrounding the wound softens (“macerates”) from the drainage and callouses form around the area of the wound. To promote better healing, Marie used a small razor-like device to remove (“debride”) the damaged and calloused skin and cleaned the wound bed with antibacterial agents. (One of the few advantages of diabetic nerve damage (“neuropathy”) is that I felt no pain during the process).
Research studies over the past ten years led to the discovery and commercial development of material derived from human and animal tissue that can be applied (grafted) to the wound bed to promote healing. In my case, Marie alternated the application of grafts made from the tissue of human placentas and pig organs (which we euphemistically referred to as “the baby” and “the pig”). The grafting material consists of a small patch of paper tissue-like material that is simply placed on the wound bed under a gauze bandage. In addition to the grafts, Marie applied a variety of topical gels and absorbent dressings designed to prevent infection and minimize the effects of excess drainage. She finished the process by wrapping my foot in surgical gauze and ace bandage. I was usually in a wheelchair during my visits but was able-- though not advised (see below) ---to walk in a post-surgical sandal.
The periods between my treatments were just as important to the healing process as the treatments themselves. While I give Marie an A+ for her work, I deserve a C at best for mine --- and, had it not been for my wife’s assistance in at-home wound cleaning and dressing changes, I likely would have flunked the course. The home care advice was clear and straightforward: keep my foot dry and clean, dress and bandage the wound daily and, most importantly, stay off and elevate my foot as much as possible! My wife did most of the wound cleaning and dressing. She earned an A. However, the second part of home care –minimizing walking to reduce pressure on the wound -- was my responsibility. I earned an F. (Actually, my wife and I could have shared an A if she had succeeded in tying me to the bed –which was not for the want of trying). The result is that, as of today, after some ten months of quality wound care, my incision is still not fully healed and I still am unable to engage in normal activity. Had I followed instructions and remained off my foot, I probably could have recovered after a few months of wound care. Bottom line: don’tdo whatI did; when your foot carespecialist says “non weight-bearing -, do what she says!!
By the end of December, about eight weeks ago, we thought that the incision had healed and Marie decided no further treatment was necessary. I returned home, started wearing my Siren® diabetic socks with diabetic shoes and orthotics and began to enjoy a relatively normal (albeit pandemic-ridden) life. A few weeks later, I noticed blood spots on the carpet. The incision had reopened! (Expletive deleted).
Siren Socks are innovative smart socks that detect potential issues with your feet. Siren Socks are an FDA-registered Class I medical device and are for people with neuropathy.
The socks measure your foot temperature. Temperature monitoring has been shown to help prevent diabetic foot ulcers in multiple clinical studies clinical studies over the past 20 years and is considered the gold standard in diabetic foot care.
The information from the socks is monitored by licensed nurses who contact you regularly to check on your health and the status of your feet. Your doctor review any issues that arise and determine if a clinic visit is necessary.
Siren Socks are covered by Medicare, Medicare Advantage, and many private insurance plans.
Interested patients can find a Siren-Certified Provider near them and begin the enrollment process by clicking here.
Siren Socks are smart socks that help detect potential issues with your feet. Siren Socks are an FDA-registered Class I medical device and are designed for people living with diabetes and neuropathy. The socks measure your foot temperature. Temperature monitoring has been shown to help reduce the number of diabetic foot ulcers in multiple clinical studies over the past 20 years and is considered the gold standard in diabetic foot care. The information from the socks is monitored by licensed nurses who contact you regularly to check on your health and the status of your feet. Your doctor reviews any issues that arise and determine if a clinic visit is necessary. Siren Socks are covered by Medicare, Medicare Advantage, and many private insurance plans. Interested patients can find a Certified Siren Provider near them and begin the enrollment process by clickinghere.