My Diabetic Foot Wound – the Beginning

One of the reasons for starting this blog in the first place was to write about what happened with my foot – two months later, I am finally starting to do that!  Because this was a two year ordeal (more like nightmare!), I thought it would be better if I break it up into sections.

Like a lot of other people, I learned the hard way the importance of checking your feet every day.  My first ulcer was a huge hole in my foot that I don’t know for sure what caused it.  I discovered it on a Friday morning while getting ready for work.  The day before, I had been at a client’s office that had a gravel parking lot and my first thought was that a stone came thru my shoe.  I looked at the shoes I had worn the day before and although there was blood, there was no hole coming thru the bottom of the shoe.  I then looked at all the shoes I had worn that week.  Monday evening, I had gone to a party at my cousin’s house and wore some sandals I rarely wore – they also had blood on so I knew that it had happened before Monday evening.

The weekend before, I had been outside with my dog Nicky without shoes on.  I would always just stand on my deck and wait for him.  That weekend, my neighbor was also outside so Nicky had to go pay a visit – she had two Yorkies so I guess he knew she was a Yorkie lover also.  I walked in the grass without my shoes on so it is possible I stepped on something that day.  Nicky liked to chew on cow hooves.  He liked to lie on the floor next to my bed and would frequently leave his cow hooves there for me to step on when I was getting out of bed.  Although I did not remember doing that, that was something that I could envision doing & just keep on going.

That particular ulcer took about 6 months to heal.  After that, I started paying more attention to my feet and now check them every day.  I have always seemed to have problems with my feet though.  My podiatrist when I lived by Harrisburg used to joke that I was in there so much he was going to put a sign on one of the exam rooms “Kelly’s room.” 

When the ulcer from h*ll started in March, 2005, I was checking my feet daily.  I found a small crack on the heel of my foot from my skin being dry.  I did what I was supposed to do and immediately called my podiatrist’s office to get an appointment.  His office was always very good about getting diabetics in right away – they always asked when I called for an appointment if I was diabetic.  I started treatment for the ulcer right away.

Unfortunately, the ulcer was not healed when I moved away in June.  That meant finding a new doctor. The doctor I moved away from was someone I had seen forever and he was very good.  I had a 3 week wait to get in with the new doctor and it did not matter to them that I had an ulcer or was diabetic.  I guess that should have been my first clue!

I started having drainage from the ulcer plus was having pain in my foot.  Both of those were dismissed by the new doctor.  The Sunday of Labor Day weekend, I got really sick.  Because I have gastroparesis and a history of stomach problems, when I was sick in the stomach, I “assumed” it was related to the gastroparesis.  By Wednesday evening, I could barely get out of bed and even Ginger Ale was making me sick so it was off to the ER. 

One of the things the triage nurse does when you get to the ER is check your temperature – mine was 103.  I did not even realize that I had a fever.  The ER doctor came in and talked to me, did some blood work & an x-ray of my stomach.  He later came back in and asked besides being diabetic, what other health issues did I have going on.  He said that they wanted to admit me to the hospital.  After he walked out of the room, I looked down and saw the blue surgical shoe on my foot and realized that I had not mentioned the ulcer on my foot.  It was also pretty obvious and he did not ask about it either.

After I got up to a room, another doctor came in to talk to me.  He asked me about any open wounds and I told him about the ulcer on my foot.  They were going to call a podiatrist and I gave him the name of the one that I had been seeing.  Another doctor from the podiatrist’s office came in.  She was the one that informed me that my SED rate was very high, which was a sign of an infection.  An infectious disease doctor also came in.  He ordered a culture of my foot.  A couple days after being admitted, I had a big purple bubble on the bottom of my foot.  The infectious disease doctor was surprised that when they did the culture, they did not break that.  When the culture came back, I was told that I had a little bit of everything growing in there – Streptococcus agalactiae, Staphylococcus aureus, candida species and Enterococcus avium. 

The podiatrist ordered an MRI.  I went for my MRI Friday evening.  Saturday morning, the podiatrist came in and she said that the MRI was not in my chart yet.  She was going down to radiology to look at it.  She said that if there was a problem, she would come back & talk to me.  She would not come back unless there was a problem.  She did not come back so I “assumed” there was not a problem.  Later, the infectious disease doctor came in and said that I had osteomyelitis – an infection that set into the bone.  I later found out from the podiatrist’s partner that she disagreed with the radiologist about the osteomyelitis and she did not think that I had it.  Needless to say, the radiologist was right!

I had a PICC line put in so that I would be able to have IV antibiotics after being released from the hospital.  I was released from the hospital on Wednesday, one week to the day after being admitted.  The hospital made arrangements for home nurses to come in and the antibiotics to be delivered. 

After I was home, my foot kept looking worse.  I made an unplanned trip to the doctors on the advice of the home nurse.  That was a wasted trip.  On the encouragement of my sister (a nurse) and the home nurse, I made an appointment with a local wound center that was connected with the hospital that I had been in.

My sister took me to the first visit and was in the room when everything was being discussed.  The doctor discussed possible surgery, putting antibiotic beads in my foot or just trying antibiotics to start with.  He made the decision to try the antibiotics and hold off on any surgery. He did another culture.

A few days later after the culture came back, the doctor at the wound center called to inform me that I had MRSA.  I had Staphylococcus aureus, which was showing up as MRSA, and also Pseudomonas aeryginosa infection.  They would be switching the IV antibiotic that I was on to Vancomycin and also started me on oral Cipro.

To be continued …