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Diabetic. Gangrene in feet with smelly. Has BP, consume alcohol and smoke. Has to undergo operation. Suggestions?

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Answered by

Internal Medicine Specialist
Practicing since : 2005
Answered : 353 Questions
Subject" Gangrene

Dear Doctor,
I have a concern on the issue that I am facing in the hospital. My father has been admitted in the hospital on 31-05-2013 for gangrene treatment. I don’t know how bad is this gangrene but as I spoke to the doctor who is a orthopaedist, he said that the smell was very bad and it has started on 3rd finger of his feet which has been partially amputed.
My father is a diabetic, has blood pressure, consumes alcohol & a smoker too. From past few days, after undergoing operation, he has been put on antibiotics till 05-06-2013. His diet was very strict as it only consisted of fruits, boiled vegetables, rice & no salt.
I have been always trying to get in touch with the doctor, for his daily improvement. However, I felt the doctor wasn’t very efficient in giving the information which I felt later, I will come to that point latr.
The doctor first said that we would do some test which can detect if there is any growth of gangrene or not. However, the test had to be conducted before the operation . Now, why did I say ‘operation’ is that because on 5th XXXXXXX that is yesterday without conducting test, he said me that there are dead skin which needs to be removed & later also he said that the 3rd finger which was half amputed would have to be completely amputed for better recovery.
Today, the doctor without my consent has taken my father for the operation & God knows are they really treating him or trying to achieve their targets with this treatment.
Please guide me how do I come to know is this a genuine thing or are they minting money. I wanted a second opinion for the same.
Posted Sat, 6 Jul 2013 in General Health
Answered by Dr. Omer 1 hour later

I am Dr.Omer and i am here to help you with your query

I am really sorry to hear about your father amputation

As you have said that your father is a known case of diabetes , high blood pressure , a smoker , drinks alcohol , had gangrene in his toe

The disease of your father is known as "Diabetic Foot"

As the names indicates diabetic Foot , meaning due to uncontrolled sugar there is narrowing of your father foot vessels , especially toes , due to continous accumulation of sugar , fat in the vessels of the foot , the blood supply becomes decreased and the area supplied by that vessel dies known as Diabetic foot or gangrene

As there are other factors that are also contributing in narrowing of vessel in your father that is smoking +alcohol

The vessels of the foot toes are known as "End arteries" , meaning the toes have only one blood supply , and if that single vessel becomes occluded , the toes die

The test we do to check at what level the narrowing is , known as DOPPLER ULTRASOUND , just to see whether by giving blood thinners , the blood will flow easier or not

But if the toes are totally black , bad smelling this indicates severe narrowing of vessel and hence less blood supply , and usually the surgeon dont do this test as it is obvious that there is no returning point and we do amputation , to prevent the infection of dead tissue to spread in whole of the body

The best plan of action for your father is "DEBRIDEMENT" , meaning we slowly take of the dead tissue day by day , till we get the healthy tissue , and hence trying our utmost to save the FOOT.

After doing few debridements , if we get a healthy tissue , we start on broad antibiotics , with blood thinner , and keep on reviewing the patient to check whether the gangrene is not spreading upward

What you can do for your father is , strict sugar control with insulin , lowering the cholesterol in body by statins , blood thinners like aspirin , regular exercises , regular self checking of feet , immediatley stop SMOKING +ALCOHOL ( if not possible decrease it as much as you can) and keeping the bp in the range of 125/80

I hope this explain your query in detail , and i think your surgeon is trying to protect your father feet at the expense of removing dead tissue , this is the best plan of action

Wishing your father a speedy recovery

Take care
Above answer was peer-reviewed by
Follow-up: Diabetic. Gangrene in feet with smelly. Has BP, consume alcohol and smoke. Has to undergo operation. Suggestions? 10 days later
Dear Doctor,

As per previous conversation, he is now recovering however his feet is unbearable to watch, its hollow.

My main concern is that now he is there for mare than 2 weeks. Now, doctors are saying that we have to do skin grafting which would take another week for his feet to recover and then grafting.

My concern is that till now doctors are not saying the approximate total cost for the treatment done.

Can you please help me in knowing the approximate cost like willl it cost Rs 1 Lakh as expenditure including all hospital charges & doctors charges.
Answered by Dr. Omer 2 hours later
Hello again

I am really happy to know that your father health is improving

In diabetic foot when we do debridement , usually a hole is left , to cover that space we take a skin flap from thighs , and fill the hole in feet

This procedure of skin grafting is expensive , in Pakistan it takes around 60,000 for procedure + antibiotics + room charges

In Pakistan debridement + 2 week hospital stay + antibiotics will be around 60,000

So you can total it up , and in your country it may be cheaper than that.

I would recommend to go to your doctor and clear up the XXXXXXX before proceeding for skin grafting

Skin grafting is must as skin infections will be more without grafting and more chances of losing whole foot

Hope that helps

Wishing your father a speedy recovery

Take care
Above answer was peer-reviewed by
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