Wednesday, April 24, 2013

Insensitive

Long story short on the latest malady:
I over-exerted from the third week of March through the first week of April, with a steady increase in activity. This caused no immediate strain, but inflamed the bad tendon, which inflamed the Charcot Foot, which caused the ulceration of my ankle. The open wound is typically encased in a Crow Boot, which is a tight, foam-lined brace that supports the permanently I have to wear the Crow Boot at all times or risk further ankle collapse whenever I put weight on the right leg. The Crow Boot can be very warm on the leg, and a symptom of Charcot Foot itself is temperature of the foot that can be seven degrees Celsius above the rest of the body.
This forms the ideal conditions for bacterial growth, dark and warm and moist. The problem getting so bad so fast is not a sign that I am a bad diabetic who does not take care of himself. It is a matter that I am a diabetic with nerve damage who could not feel the break in the skin on the foot. I am a blind diabetic who could not see the break in the foot, or blood on a dark sock.
Two things made me aware of the problem. The first was a lingering smell. I wondered what the bad smell was in the kitchen. I noticed it in another room. I thought the cat box in the bathroom had a funky odor. When I went to bed that night, the smell from the removed boot was overpowering. I happened to notice that the sock was wet, but not in a uniformly sweaty way. I touched what is normally a rough, dry area of skin and squished my finger in a wet hole.
I called a tenant who helps me out a lot. He came over and we cleaned things up. He found my emergency pack of antibiotics and I started those.
By specific criteria, he agreed with my decision not to go to an emergency room that night, but to get in contact with my regular foot doctor in the morning. This decision was not for financial reasons, but logistical ones. The truth is, Charcot Foot is not all that common and many doctors will not recognize it. Many, in the course of good and reasonable treatment, will do things that will increase the risk of Charcot Foot leading to amputation. I felt safer going to my doc–Thomas Mancini of North Providence–rather than to someone who I could only hope would not make things worse. I’ve been there and done that.
Dr. Mancini saw me that day. He cut away some dead tissue and was surprised by the amount of bleeding. Nerve damage is not the same thing as circulation problems. He prescribed Augmentin, a powerful antibiotic. I am making a concentrated effort to stay off the leg and keep the boot off when I can so the wound can breathe. I did catch the problem soon enough that the infection had not reached bone or flooded my system. The antibiotics knock me out a bit, but do not bother my stomach. I will be staying on them (and off the leg as much as possible) until the wound is healed up.
This may sound odd from a blind limpy guy, but I am lucky.

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