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chrishansenhome) wrote2010-07-09 09:25 am
chrishansenhome) wrote2010-07-09 09:25 am
Entry tags:
Pedal Mobility System vs. "feet"
I went to the Diabetic Foot Clinic yesterday.
Some background: Over the last week, HWMBO was complaining that my foot-in-a-cast smelled. I am sensitive to that, but I could not smell anything when I tried, so discounted it. On Wednesday I had asked the District (=US "visiting") nurse to come early as I had a meeting at the Diocese at noon. I was getting dressed after bathing and had my shirt and briefs on, but not my trousers. I had taken my "cast shoe" (rubber "sandal" that the cast fits into which protects it from being pounded on the floor or pavement) off in order to put on my trousers. The doorbell rang, and it was the nurse. I had to clomp downstairs without the cast shoe to let her in and then return upstairs to finish dressing after apologising for my state of déshabille.
Wednesday night I took the cast shoe off before bed and found that the bottom of the cast was moist. Apparently my little excursion downstairs had cracked the cast and the fluid inside had begun to leak out. I spent Wednesday night and Thursday morning worrying about this, and thus slept little. Thursday afternoon I made my way to Kings.
When I got into the chair, I apologised for the odour and told my story about the cast cracking. The podiatrist wasn't too worried about it, and cut off the cast. However, my worst fears were partially true. The ulcer on the bottom of my foot is filling in nicely. It is almost at skin level and beginning to get smaller. However, I had been concerned about a pressure sore on the side of my foot, and had told the podiatrist (another person) during the previous visit to pad it extra well. This pressure sore had bothered me all during the two weeks the cast was on and, when it was cut off, they found that it had macerated (ie, become soft and squishy) down to the bone. They removed all the soft squishy bits, scheduled me for an X-ray next Wednesday, and gave me a different type of cast called a pillow cast. A pillow cast is basically a cast over the foot only, where the top of the cast is cut off, there is extra padding placed on the foot both underneath and to the side, and the foot rests in the cast as though on a pillow in a cradle. The whole thing is strapped together, and then the cast shoe is strapped on over that. A picture is, of course, worth 1,000 words.
They have sent samples to Microbiology to ensure that I am taking the best antibiotics in case this sore has developed an infection. I hope it hasn't, but one never knows. Now, in addition to giving me my antibiotics bolus, the District Nurse will have to change the dressing every other day or so. After next Wednesday's X-ray, I'm back at the Diabetic Foot Clinic for a further assessment and the like. They are likely to call me if I need different antibiotics or an additional one (surely, not!)
All this brings me to the question to which I allude in the subject line: Are my feet just "feet" in the abstract, or are they a "system" where actions to help one part of the system can have an effect on other parts of the system.
I think that they are a system, and the fact that something that helped the ulcer on the bottom of my foot (a "hard cast") has harmed another part of my foot (the right-hand side) is starting to worry me. I do not believe (and I have asked the clinic whether they are trained to try to anticipate this kind of situation, and they say that they have) that "feet" are just "feet". They are a system that enables us to get around and generally exist in a world of steps and of foot fetishists (I just put that last part in to see if you were still awake…). The weather has been rather warm lately, and I've begun to suffer from edema (oedema here) in my legs and feet (collection of fluid in my feet and legs that swells them up). The staff at the foot clinic was aware of the edema. The fact that my leg and foot was in a cast made the edema worse. I suspect that my right foot swelled up enough to rub the sore on the outside of the foot just enough to begin macerating. The fluid from the ulcer just added to the joy inside the cast.
I have tried to be a proactive patient. The nurses on the IV team were ecstatic over my observations about my PICC line—one of the nurses called me Wednesday evening and we talked about it for quite a long time. I did point out to the podiatrist two weeks ago that I needed extensive padding on the outside of my right foot in order to avoid the soreness there, and he did chip away at the sore then before padding it. Were they listening? Am I just talking into the air? Are they perhaps a bit touchy about the patient contributing to his own treatment? I don't know, and their professionalism so far does belie those questions. I owe them a lot, but I just wonder: are the medical staff and I just firefighting, or are we trying to prevent the arsonist from burning the building down?
I came home in a very sad mood. I noodled around for the rest of the afternoon and, when HWMBO called to say he was on the way home and I should start cooking, I told him that I had gotten bad news at the clinic and I wasn't up to cooking. When he got home we ended up having a little row about this whole situation and I finished the row by sitting in my easy chair weeping over the entire sorry business. Luckily we kissed and made up even before dinner was over. But the big question hangs in the air: will these little setbacks end up costing me my well-being in general and make me into a sad recluse afraid to even venture out of the door for the post in case something happens to my feet yet again? Will I never be able to travel back to America to see my family, nor to Singapore to see all my friends there, nor anyplace else in the world outside the Elephant and Castle? I am beginning to be terribly afraid that this will happen, whether I try to prevent it or not.
I am unsure how to proceed. I may write a note and bring it to the Clinic next week and ask for a consultation with the head of the clinic to discuss the whole situation. I don't think he has the time, frankly. I now know what it is to be at the end of my tether. Something will, indeed, snap. I don't know what. I do not wish to be on psychoactive medication if I can at all avoid it; I have never been clinically depressed before in my life and HWMBO has, as usual, been a Godsend as he sorts out parts of my life that I do not currently have the energy or ability to sort out for myself. I am willing to try for counselling of some sort, but the wait on the NHS for that is likely to be months if not years.
There was a bit of good news: the ulcer on my left foot has now officially healed. It will require padding for a month or so to ensure that the scar that is left has toughened up enough to be able to withstand the stresses and strains of normal peripatetics. To get to this point only took a year. The circulation in my left leg is not as good as the circulation in my right—the fact that the ulcer on the bottom of the right foot has healed as quickly as it has is external evidence of that. However, I think I need answers to my questions and a system of treatment that takes into account not only the presenting conditions, but also my general health and well-being as well as the general condition of my feet.
Some background: Over the last week, HWMBO was complaining that my foot-in-a-cast smelled. I am sensitive to that, but I could not smell anything when I tried, so discounted it. On Wednesday I had asked the District (=US "visiting") nurse to come early as I had a meeting at the Diocese at noon. I was getting dressed after bathing and had my shirt and briefs on, but not my trousers. I had taken my "cast shoe" (rubber "sandal" that the cast fits into which protects it from being pounded on the floor or pavement) off in order to put on my trousers. The doorbell rang, and it was the nurse. I had to clomp downstairs without the cast shoe to let her in and then return upstairs to finish dressing after apologising for my state of déshabille.
Wednesday night I took the cast shoe off before bed and found that the bottom of the cast was moist. Apparently my little excursion downstairs had cracked the cast and the fluid inside had begun to leak out. I spent Wednesday night and Thursday morning worrying about this, and thus slept little. Thursday afternoon I made my way to Kings.
When I got into the chair, I apologised for the odour and told my story about the cast cracking. The podiatrist wasn't too worried about it, and cut off the cast. However, my worst fears were partially true. The ulcer on the bottom of my foot is filling in nicely. It is almost at skin level and beginning to get smaller. However, I had been concerned about a pressure sore on the side of my foot, and had told the podiatrist (another person) during the previous visit to pad it extra well. This pressure sore had bothered me all during the two weeks the cast was on and, when it was cut off, they found that it had macerated (ie, become soft and squishy) down to the bone. They removed all the soft squishy bits, scheduled me for an X-ray next Wednesday, and gave me a different type of cast called a pillow cast. A pillow cast is basically a cast over the foot only, where the top of the cast is cut off, there is extra padding placed on the foot both underneath and to the side, and the foot rests in the cast as though on a pillow in a cradle. The whole thing is strapped together, and then the cast shoe is strapped on over that. A picture is, of course, worth 1,000 words.
They have sent samples to Microbiology to ensure that I am taking the best antibiotics in case this sore has developed an infection. I hope it hasn't, but one never knows. Now, in addition to giving me my antibiotics bolus, the District Nurse will have to change the dressing every other day or so. After next Wednesday's X-ray, I'm back at the Diabetic Foot Clinic for a further assessment and the like. They are likely to call me if I need different antibiotics or an additional one (surely, not!)
All this brings me to the question to which I allude in the subject line: Are my feet just "feet" in the abstract, or are they a "system" where actions to help one part of the system can have an effect on other parts of the system.
I think that they are a system, and the fact that something that helped the ulcer on the bottom of my foot (a "hard cast") has harmed another part of my foot (the right-hand side) is starting to worry me. I do not believe (and I have asked the clinic whether they are trained to try to anticipate this kind of situation, and they say that they have) that "feet" are just "feet". They are a system that enables us to get around and generally exist in a world of steps and of foot fetishists (I just put that last part in to see if you were still awake…). The weather has been rather warm lately, and I've begun to suffer from edema (oedema here) in my legs and feet (collection of fluid in my feet and legs that swells them up). The staff at the foot clinic was aware of the edema. The fact that my leg and foot was in a cast made the edema worse. I suspect that my right foot swelled up enough to rub the sore on the outside of the foot just enough to begin macerating. The fluid from the ulcer just added to the joy inside the cast.
I have tried to be a proactive patient. The nurses on the IV team were ecstatic over my observations about my PICC line—one of the nurses called me Wednesday evening and we talked about it for quite a long time. I did point out to the podiatrist two weeks ago that I needed extensive padding on the outside of my right foot in order to avoid the soreness there, and he did chip away at the sore then before padding it. Were they listening? Am I just talking into the air? Are they perhaps a bit touchy about the patient contributing to his own treatment? I don't know, and their professionalism so far does belie those questions. I owe them a lot, but I just wonder: are the medical staff and I just firefighting, or are we trying to prevent the arsonist from burning the building down?
I came home in a very sad mood. I noodled around for the rest of the afternoon and, when HWMBO called to say he was on the way home and I should start cooking, I told him that I had gotten bad news at the clinic and I wasn't up to cooking. When he got home we ended up having a little row about this whole situation and I finished the row by sitting in my easy chair weeping over the entire sorry business. Luckily we kissed and made up even before dinner was over. But the big question hangs in the air: will these little setbacks end up costing me my well-being in general and make me into a sad recluse afraid to even venture out of the door for the post in case something happens to my feet yet again? Will I never be able to travel back to America to see my family, nor to Singapore to see all my friends there, nor anyplace else in the world outside the Elephant and Castle? I am beginning to be terribly afraid that this will happen, whether I try to prevent it or not.
I am unsure how to proceed. I may write a note and bring it to the Clinic next week and ask for a consultation with the head of the clinic to discuss the whole situation. I don't think he has the time, frankly. I now know what it is to be at the end of my tether. Something will, indeed, snap. I don't know what. I do not wish to be on psychoactive medication if I can at all avoid it; I have never been clinically depressed before in my life and HWMBO has, as usual, been a Godsend as he sorts out parts of my life that I do not currently have the energy or ability to sort out for myself. I am willing to try for counselling of some sort, but the wait on the NHS for that is likely to be months if not years.
There was a bit of good news: the ulcer on my left foot has now officially healed. It will require padding for a month or so to ensure that the scar that is left has toughened up enough to be able to withstand the stresses and strains of normal peripatetics. To get to this point only took a year. The circulation in my left leg is not as good as the circulation in my right—the fact that the ulcer on the bottom of the right foot has healed as quickly as it has is external evidence of that. However, I think I need answers to my questions and a system of treatment that takes into account not only the presenting conditions, but also my general health and well-being as well as the general condition of my feet.
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