Diabetes Self-Management Blog

My incision from surgery on April 8 to repair a torn Achilles tendon is not healing well. As I understand it, it could be worse, but it isn’t getting any better. So I’m having a procedure that should aid in healing. As I write this, I haven’t had it yet. By the time you read it, I’ll be back home.

During the outpatient procedure, I’ll be taking a nice nap — thanks to the anesthesiologist — while the doctor does a thorough cleaning. A vacuum will be attached to suck the fluids and other gunk out of the wound and to draw the edges of the incision together. Oh, joy.

Mother, who wants to pamper me for a few days, is here for the week, and I’ll apparently also be visited by home health care so they can change the dressings and keep the vacuum-assisted closure, or V.A.C., device (a.k.a. Kirby) happy. I’m used to being alone much of the time and do not like to be hovered over. This is going to be a fun week.

Kirby is no Wal-Mart–variety vacuum. He gets rented at a rate of $146 per day and falls under my durable medical equipment (DME) coverage, which is capped at $2,500 per year. This had better not take more than a couple of weeks: I’d rather spend my money on something else. Like a trip. I tried to find out how much it cost to buy a V.A.C. device, just to see how that $146 a day is justified, but the companies are keeping that a secret. If any of you find out, let me know. I hope there’s solid gold in that sucker (pun may be intended) and not just gold leaf.

The whole deal got my imagination working overtime. I was diagnosed with Type 2 diabetes in 1986 with a fasting blood glucose of 311 mg/dl, meaning I’d already had it for a few years. Unlike Type 1 diabetes, which comes on rather suddenly, Type 2 can develop gradually and hide for years, frequently doing its damage before it’s even discovered. That’s why people need to get checked for Type 2 diabetes so it can be found early. That way, you can work from close to the beginning of when the condition develops to lower your risk of complications. It isn’t fun, but it’s better than finding out you have Type 2 diabetes after your heart attack, stroke, or eye damage occurs.

Despite the 23-plus years I’ve known I have diabetes and all the years before when I didn’t have a clue, I’m pretty much complication-free. Which is to say, I don’t know of any complications or, at least, not of any major ones. My eyes are fine, I have feeling in my feet, and stuff like that. I have reduced blood flow to a small portion of my heart, my microalbumin levels are slightly elevated (but have remained at the same level for years), and I’ve had two impinged shoulders, which people with diabetes are more prone to.

As an aside, did you know that one of the risk factors for Achilles tendon problems is — you guessed it — diabetes?

Anyway, when I got an infection and the wound from the surgery didn’t heal, I decided that this was it: I was beginning my downhill slide to a plethora of diabetes complications. I pictured myself going for years with what my granddaughter says is a “big, gaping hole” in the back of my leg or, worse, no leg. I wondered what would come next: A heart attack? A sudden deterioration of my eyes? End-stage kidney disease? Gastroparesis?

With plenty of people more than happy to tell you about all of the ills that will befall you… sometime… during your shortened life, there was plenty to dwell on.

When my podiatrist called me to answer a question I had about Kirby, I shared with him that, for the first time since diagnosis, I really felt as if I had diabetes since this was, apparently, the beginning of the end.

He quickly convinced me otherwise, saying that, while diabetes most likely didn’t help, infection and healing problems after Achilles tendon surgery were not limited to people with diabetes.

“Traditionally,” he said, “any incision over the Achilles tendon has a relatively high chance of complications. The soft tissue between the tendon and skin is thin and has a limited blood supply. This is true of all individuals. The diabetes might slightly increase the risk, but over all the area is challenging.”

Whew! Dodged that bullet!

However, it isn’t time to become complacent. While surfing around the Internet looking for information about diabetes and wound healing, I came across the Web site for the Wound Healing Center of New York-Presbyterian Hospital/Columbia University Medical Center that helped me better understand how diabetes can affect wound healing. According to the site, poorly controlled diabetes can cause a variety of issues, ranging from the development of skin breaks and infections, to difficulty fighting these infections, to clogged arteries that prevent adequate blood flow from reaching wounds.

I always try to remember that it isn’t diabetes itself that causes complications: It’s poorly controlled blood glucose that does the dirty deed. (And having good genes probably doesn’t hurt.)

Complications do more than inconvenience us when they occur: The darned things are costly, too. Not that taking care of diabetes is easy on your wallet, but at least the daily expenses of medicines and supplies to care for diabetes don’t come close to what Kirby can set you back.

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Comments
  1. you can heal!!! Try some Arnica ointment and orally. It is homeopathic remedy that encourages your body to produce healing naturally.

    The pain meds slow the healing process down so try to go with ice!

    I had pins and screws put in for 3 ankle fractures and healed fine ….slow….but fine. Took lots of Vitamin C, E, Alpha Lipoic acid and ate mostly vegetables, fruits and soups.
    Try to stay positive by thinking good thoughts.

    Good luck

    Bhakti

    Posted by bhakti lila |
  2. I am curious about the ruptured Achilles tendon. Were you taking a statin drug prior to the injury? My brother suffered this same
    injury and it was determined that it was due to the statin drug
    he was taking. My husband suffered pain and transient global
    amnesia, also due to statins. The ER docs did not have a clue, but when I went to the computer and typed in transient global amnesia, I learned a lot. I have been a nurse a long time and have learned to listen to my patients carefully, and to take a very close look at
    their medications. There is an interesting article here entitled
    “Stronger Warning for Gastroparesis Drug.” I have seen tardive dyskinesia and a severe psychotic reaction due to this medication.

    Posted by Cookie |
  3. My brother, who has had limited circulation in his leg since he was 17 (now 54) swears by wheat grass poultices for healing. he had a tiny cut on the back of his heel many years ago, and was very close to amputation, after nothing would work to heal the ulceration that formed there. The doctors were pushing for a pig skin graft. He drank wheat grass juice and used the poultices frequently and healed himself. He was vegan then but later went ovo-lacto.
    He later became an acupuncturist and herbalist. Has kept himself healthy these many years. Good Luck!

    Posted by Tami Breimann |
  4. I have read where ordinary honey applied to an open wound and covered with gauze does wonders. The story I read told of a surgeon that had a patient that had an ulcer on his leg and wouldnt heal. He was attending the patient and said to the older nurse with him that he wished something would work on the open sore. She said an old remedy is honey. He tried it and worked healing up the wound in a few days. After that he used honey a lot of difficult wounds. It might work for you and hope that it does.

    Posted by Richard Sullivan |
  5. Get well soon, Jan. I just want to caution against one of these home remedies. Ice would be a very bad idea. And pain medicines do not slow down healing. Quite possibly it’s the reverse. I don’t know about the honey or the wheatgrass poultices.

    $140 a day is outrageous, like most of the rest of American medicine. Looks like you should be able to buy a V.A.C. pump online and a drainage bottle for about $100. You might need some help to set it up, though. I’m not sure who would help you with that.

    Posted by David Spero RN |
  6. Yes, I do take a statin and have for some time. I hadn’t heard about a statin–tendon connection, but have found out that some antibiotics I have/am taking put you at higher risk for tendon problems. That, however, appears to be a matter of whether it’s being taken long- or short-term. Long-term would put you at higher risk. On the other hand, infections aren’t good to have, either. Sometimes you do what you have to do and hope for the best.

    As far as alternate remedies are concerned, I’ll confess to being an old fogey. I tend to try conventional means first. If that doesn’t work, I’m more open to alternative methods. With the wound I have now, I did ask about manuka honey. For now, the wound V.A.C. method appears to be working with the visiting nurse saying this morning that it’s looking good. My husband, who’s seen the area from the beginning, agrees. I’m also experiencing less pain than I had been, so it’s all good for now.

    Jan

    Posted by Jan Chait |
  7. Don’t waste your time with homeopathy: research shows that it is useless. See http://www.ncbi.nlm.nih.gov/pubmed/9820349

    Posted by Gary |

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