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Dr. Andrew Rynne
MD
Dr. Andrew Rynne

Family Physician

Exp 50 years

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Tell Me The Treatment For Ulcer

Plan of care that outlines medical management, surgical management and mechanical management (like Offloading the affected foot) in Open Ulcers? Nature of Patient: Female, 49, Type 2 Diabetes for 7 years, Bilateral Great toe ulcers, Non healing for last 1 year. Right: 2 cm * 1cm, Left: 3 cm* 2 cm Margins: Irregular Depth: Right: ½ cm, Left: ¾ cm Findings: HbA1c: 9%, Vibration Perception Threshold (VPT) & Hot and Cold perception (HCP): Grossly Impaired, Doppler: Normal, Ankle Brachial Index (ABI): Right- 1.01, Left- 0.92 1)What are the other information do u require from the patient? 2)what is the primary goal of treatment for her? 3)Do u think her diabetes control is adequate, and if not what might you suggest? 4)What teaching would you do with this patient? 5)What are the plans regarding treatment of the ulcer?
Fri, 21 Jan 2011
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General & Family Physician,  's  Response
Hi,

Welcome to Healthcaremagic Forum

Well the query is informative here are my opinions and ideas,

1)History about smoking , alcohol ( if any ),Atherosclerotic illness and previous treatments for the ulcer would be more helpful.

2)The primary goal of mine would be for a conservative management and preserve the toes if possible .

3)No , the diabetic control is not much convincing as the HbA1c is boredrly higher.Reading ranging from 4 to 7 would be favorable.Control achieved by diet modification is a long standing type as the treatment of the toe ulcers needs that.

4)I would like the patient to stay on low carb diet and maintain good cleanliness of the ulcers by frequent sterile dressings with a better antibacterial cream.

5)First i would like to ask for a Culture sensitivity test of the discharge from both the ulcers separately , the success of the medical management if planned depends on these reports. If we dealing with resistant variety debridement may have to be considered.If the wound is sterile then lowering the sugar levels by diet and good sterile dressing with antibacterial would be sufficing intervention.

Thanks for visiting Healthcaremagic.com

Take care, bye
I find this answer helpful
  Anonymous's Response
Anonymous's  Response
I liked the reply. I wanted to know the tersm regarding VPT and ABI and HCP and Doppler terms..
N even i would love to know majour regarding plan.

Thanks
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Tell Me The Treatment For Ulcer

Hi, Welcome to Healthcaremagic Forum Well the query is informative here are my opinions and ideas, 1)History about smoking , alcohol ( if any ),Atherosclerotic illness and previous treatments for the ulcer would be more helpful. 2)The primary goal of mine would be for a conservative management and preserve the toes if possible . 3)No , the diabetic control is not much convincing as the HbA1c is boredrly higher.Reading ranging from 4 to 7 would be favorable.Control achieved by diet modification is a long standing type as the treatment of the toe ulcers needs that. 4)I would like the patient to stay on low carb diet and maintain good cleanliness of the ulcers by frequent sterile dressings with a better antibacterial cream. 5)First i would like to ask for a Culture sensitivity test of the discharge from both the ulcers separately , the success of the medical management if planned depends on these reports. If we dealing with resistant variety debridement may have to be considered.If the wound is sterile then lowering the sugar levels by diet and good sterile dressing with antibacterial would be sufficing intervention. Thanks for visiting Healthcaremagic.com Take care, bye