01/28/2010 at 5:19 AM Leave a comment

Those were my words to myself yesterday when I saw a man’s toe. He had come in for his usual yearly visit ( he should come more often but once is what he makes time for) to get his diabetes medicines. He is middle aged man in very good shape. He has maintained his weight, checks his sugar with regularity and keeps his sugar in very precise control. He had no complaints or questions. He plans to start exercising in an effort to decrease his need for medicine and to prevent weight gain. His work is going well.

There were no problems, or concerns. I checked his ears, eyes, etc. and was working my way down to his feet. He mentioned that he had a small problem with his large toe. No big thing just a small sore. I expected to see athletes foot or fungus nail. What I saw was overwhelming. He has a whole in his foot. The whole is at least 3/8 inch deep and wide. There is necrotic tissue inside it and he has no feeling in it. To make matters worse he was emphatic that it was much worse than this when he first noticed it 8 weeks ago! Even more significant is that he never felt anything. He noticed it solely because he saw some drainage on his sock. I was clearly way more worried about it than he had ever been.

He is a very intelligent knowledgeable man who follows directions unless in means coming into the office. (on his side, he does work very hard; on my side, we open evenings and saturdays). I am hard to faze, but his did it. I think it was the nonchalance he had about it and how it caught me by surprise.

I sent him to a would care specialist so they can debride away the dead tissue and begin the proper care. I will be anxious to follow the results. He could very well heal up completely with some care and attention. But on the other hand if the infection has reached the bone and if his sensation in his feet are that bad, he could end up losing the toe. It is also disturbing that he developed this while his sugars where under excellent control. There is no room for improvement there.

It is common for patients to come in for what they perceive as significant but is in fact trivial. This patient trivialized  a very significant problem. Good thing he was due for a refill!


Entry filed under: true story. Tags: , .

A patient does what a patient has to do. A story I wrote about my daughter many years ago.

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