Dear Dr. Roach: My father is an 84-year-old diabetic. He has had a wound on his foot (on the inner side of his right foot, near his big toe) for about five months. He has been treated by a podiatrist, who has debrided the wound every week. He prescribed antibiotics when the wound has looked infected. A visiting nurse and my mother have changed and dressed the wound regularly during these months.
This week, the podiatrist said he could see the bone in my dad鈥檚 foot, and recommended hyperbaric treatment.
Could you tell me what your opinion is of this treatment in my father鈥檚 case? Do you know if it has a high per centage of success?
C.O.
Foot ulcers in diabetes are common and feared. Diabetes damages blood vessels, both large and small. Also, long-standing diabetes decreases the effectiveness of the inflammatory response and immune system. Finally, poor nerve function in people with diabetes combines with these other factors to predispose one to developing breakdown of the skin and development of ulcers. These ulcers can get large and deep, and when the bone is visible (and sometimes even when it鈥檚 not), the bone is infected.
In this case, there is a high risk of the need for amputation.
By far, the best way to deal with diabetic foot ulcers is to not get them in the first place. Good control of diabetes, proper foot-wear, regular checks by a professional and daily self-checks of the feet for people at high risk can reduce the likelihood of developing ulcers. Early and aggressive treatment of precursor lesions, even mild redness of the skin, ingrown toenails or fungal infection of the feet, should prompt urgent evaluation by a podiatrist.
Once the ulcer has progressed to the point where your dad鈥檚 is now, aggressive measures are called for. In addition to care by a podiatrist or orthopedic surgeon, evaluation by a vascular surgeon and a wound-management specialist may be limb- and even life-saving.
While hyperbaric oxygen has indeed been shown to be beneficial in several studies (reducing amputation rate from 33 per cent to nine per cent in one study), only an expert with detailed knowledge of your dad鈥檚 case can decide whether this is appropriate treatment. If you trust your podiatrist, I think it may well be a useful treatment. However, I would be sure that he, or a vascular surgeon, has looked at the quality of blood flow to the foot.
听
Dear Dr. Roach: My dad has an extreme case of COPD and is on oxygen. He gets winded just walking across the house. Dad lives in Montana; I live in Florida and would like him to come visit me during the cold Montana winters. I have heard that it would be easier for him to breathe at a lower altitude. People have told him that if he comes to Florida, he would never be able to go back to Montana because he wouldn鈥檛 be used to the altitude any longer. Is this true?
D.W.
Lower oxygen levels at high altitude can be a real problem for people with any kind of chronic lung disease. In those cases, supplemental oxygen or a lower altitude can make people feel better and even live longer. Given that your dad is on oxygen, a lower altitude would be similar to increasing the oxygen. He may certainly prefer Florida鈥檚 winters to Montana鈥檚.
We begin to be accustomed to high altitude in a few days, but full acclimatization takes weeks. Your dad will be able to return home after his visit.
听
Dear Dr. Roach: I鈥檓 a 42-year-old woman in good health. I am beginning a new job soon, and I feel it鈥檚 a good idea to build up my immunity before I work in this new environment. I chose an over-the-counter support supplement, but I am coming down with a cold.
I have found that I regularly react in this way to vitamins and supplements. Is this common?
D.F.
Having a strong immune system is always a good idea. But supplements, even those that say they are good for the immune system, offer no proof that they prevent colds or shorten their duration. A healthy diet, exercise and good sleep are much better for your immune system than a supplement.
Some readers insist that these products are effective for them, but the science so far has not proven it. Also, any drug, herb, vitamin or other supplement always has the potential for side effects. I would advise you to save your money.
