Medical question

[figmo]

Given someone experiencing the following:

• a couple of ulcers on their big toe
• infected bone underneath the ulcers
• when they go to the hospital they are suddenly diagnosed with Type II diabetes
• they have never been treated with antibiotics for the toe
• there's cellulitis (infected skin) on the top of the affected toe and foot

Can this person's big toe possibly be saved, or does it have to be amputated?

More to the point, is cutting off the big toe hyper-aggressive treatment if antibiotics weren't tried first?

I'm trying to find this out ASAP for a friend who looks like he's about to have his big toe lopped off this afternoon.

Comments

[redaxe.livejournal.com]

Cellulitis is nasty (I've had it). Type II diabetes complicates lots of medical treatment, particularly that of infection, and also is well known to create problems with pedal circulation. Add the infected bone, and I'm not surprised that doctors would strongly consider amputation. ISTM (and IANAPhysician) that the amount of treatment to save the toe might be prohibitive, if it's possible.

[lisa-marli.livejournal.com]

Yes, a major infection can be the first sign of Diabetes both types 1 and 2.
And losing the toe is the unfortunately outcome of such problems. Jim Pierce actually went through a lot of treatments for his feet and lost toes only after much suffering.
And having the infection spread to the rest of the body, like what happened to Harold in Denver, is even worse!
Losing One Toe is better than losing many of them, or your life, after the infection spreads.
Hope the friend heals quickly and gets that diabetes under control.

[randwolf.livejournal.com]

apipiyalotl read the list of symptoms and said, "Amputate NOW. The last thing you want is that infection to go up the bone marrow." If it does, it could kill.

[duncanmac.livejournal.com]

Diabetes in general causes blood-circulation problems. I don't think that antibiotics will be able to fix that problem. Worse, he might get MRSA afterward.

[smoooom.livejournal.com]

With out enough actual medical experience to know for for sure, I'd say the amputation is the best route. Treating a new infection in someone with diabeties is hard enough, this sounds like a long standing infection and would take a long time to treat with no garuntee that it would actually work.

[duncanmac.livejournal.com]

Caveat: as with redaxe above, I am no doctor.

[kyburg.livejournal.com]

Your friend needs to be seen right away by three people:

1. A GOOD endocrinologist.
2. A vascular surgeon
3. A infectious specialist.

It's been my experience that with that kind of issue, most will call the orthopedic surgeon and do a below-the-knee amputation. Not just the toe...the entire foot, ankle and part of the leg. (So he might be ahead of the game already....)

No, the toe is a goner. And likely may include more than one toe and the resultant wound left open to granulate from the bottom up. This is a long-term proposition - and I'm never happy to hear it.

Also in my experience, calling the vascular surgeon in to see what they can leave alone below the knee has been called hyper-agressive and risky. Tell them to get stuffed.

Oh, antibiotics are definitely in their future as well - the big guns that are only given IV in the hospital and require monitoring while being given antibiotics.

I am so sorry - a type II diagnosis with a hurty foot is NOT fun.

(My comfort level would not be satisifed with anything less, BTW. Your mileage may vary.)

[jhayman.livejournal.com]

Don't like to say me too, but me too.

My experience suggest that unless the infection is caught REALLY early it will end in amputation. Your friend is not at really early.

Part of the issue is that reduced circulation (a given in diabetes) reduces the oxygen in the tissue. That allows anaerobic bacteria (those that don't need oxygen) to flourish. We are indeed talking about gangrene, just to mention one.

Please support your friend in getting the appropriate medical advice and taking it. It must be a moment of severe panic just now, to go from an owie foot to diabetes and a possible amputation.

Warm thoughts being sent.