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His PCP can get the ball rolling by assessing the wound and maybe send your dad to a wound care surgeon for better evaluation and possible debridement.
In the interim keep the wound area clean and inspect it daily for s/s of infection, gangrene. Check for redness, pus like drainage, swelling. Elevate the affected leg and if it's a pressure sore, "float" the heels by placing a pillow at the bottom of the bed and prop up the feet to not allow them to hit the mattress.
You are doing the right thing by taking him to his PCP first. Good luck!
It sounds like you have gotten your dad to a place where he is cared for and as protected as he can be. IT's a personal decision, but, I would really give a lot of thought before bringing him home to care for. It sounds like he needs much more care than one person can provide in the home. I'd read a lot about what is likely in store in making that decision.
My LO also had issues similar to your dad's. I would beg her to get treatment, but she would ignore it. Eventually, it happened. She got Vascular Dementia. Her Primary told her one day bad things could happen and there are some things worse than death. I didn't know what he meant at the time, but, now I do. I thought he meant amputation, blindness, etc., but no. It was the dementia. She now is in the Last stage of dementia in an MC.
You can only do so much. Does your dad have an Advanced Healthcare Directive (Living Will)? I'd make sure he has that and any other POA documents so that you can help him when he is not able to give input.
My questions on the Diabetes issue:
Did the Primary get your Dad's A1C? That would be very valuable. It'll tell you what his average blood sugar level has been for the last 3 months. I don't understand why with the Metformin and Lantus that he is taking, his blood sugar is running high? If he'll go, I'd see the Endo, even though, it's a distance away. The reason is that a person can get Type I diabetes at any time in life, even as a senior. That could mean that he's not producing any insulin. So, he may need fast acting with meals. The only way to determine this is with a complete exam and blood test with Endo. Also, pills don't have any impact on a Type I. Did his Primary mention this? I don't want to scare you, but, high blood sugars long term can also cause things like Diabetic Ketoacidosis. It's horrible.
You have a lot on your plate. I hope there's someone to help you. Take care of yourself too.
Uncontrolled diabetes, established neuropathy - what is there to be puzzled about? Your father's bloodstream is full of sugar that shouldn't be there. It is very bad news for the blood's ability to supply oxygen to his body's tissues, and that is why the foot is not healing properly and why new areas of skin continually break down. He may well also have other problems by now, but step one: get him to a competent medical practitioner.
I really, really hope your father can stay in the ALF. You can visit and provide the love, but as professionals they can more easily enforce good practices than your dad would ever let you do!
Home now from dermatologists appt. he's calling it bacterium, took sample...new antibiotic, foot soak in weak bleach water!?😳...,dry it, moisturizer everywhere on foot/between toes, topical antibiotic, elevate when sitting,go back in 2 wks
I had to ask him to check other foot (I never thought to ask "foot doc" to check at other appts...I'm brain dead at times)...other foot is starting to get it now😡😥
Dad went to sit in a chair today with no arms on it at my house and hit the ground...it happened in slow motion right before my eyes...no balance at all, week legs/arms...normal person could've caught themselves...I helped him up, was a struggle (204lbs), he's ok, little cut on finger...hate to see my dad bleed. 2nd time in 2wks he's missed a chair!
Anywhoooo, I loved the puddin outta my dad today, no frustration, and laughed a lot 😊I treated this day as it could be my last one with him. I sat with him at AL as he ate his "frozen-food like lunch...he said "yes" when offered cherry pie...guess my long talk about eating healthy with diabetes on the hour drive home went in one ear and out the other....I silently judged him for his bad "choice", then hugged him gbye and said, "I love you dad"...he grabbed my hand, kissed it, and said "I love you too"..............😢😍
Today, I feel blessed
And,if, this was the last day with my dad, it will be one of my best days ever!!❤️️
I'm thanking all of you sweet, special, supportive, caring peeps here!!! And taking all advice!!!
Heavy heart/Smiling/Trusting/Gaining more confidence
Love, Bella😍
At your endo appointment, help the doc by giving the check in person a letter for doc asking for a firm recommendation that the pt be in assisted living or NH because of the lack of ability to take care of themselves as evidenced by the AIC and foot sores. Then you are able to shrug your shoulders and say, "there's nothing we can do dad, your diabetes is causing you problems, and we have to solve them before you can come home." You and I know the sores on his feet are a symptom of a bigger problem, one that he is not addressing. That means he chooses to stay in a facility. You blame other people for you not being able to give him what he wants because you follow doc's orders!
Boundaries by Townsend and Cloud is a great book.
April is coming up soon. Another few weeks isn't as important as the fact that he will be seen by a specialist. Gather all the information you can, and bring it with you in writing. If you dad has his own glucose meter, bring it in -- they will download the data. If the AL uses their meter and they write down the results, bring in that list. Find out when the readings are done (in relation to eating) and write that down. Talk to the medical director at the AL and find out if your dad has displayed symptoms when he has had such low readings. No one expects that you "should've" been on top of all these things, but now that you are seeing a specialist it would be good to clarify some of these details so you can share them.
I take my blood glucose reading before meals, because that is partly how I determine how much fast-acting insulin to take. Since your father isn't taking fast-acting insulin why would they take his before meals? Well, maybe that is just their routine for people with diabetes. But I think it would be worth confirming the timing of those readings so you can tell the endo doctor.
Getting educated via the internet is valuable. BUT it is not the same as having many years of training and experience and having a license to practice medicine.
The problem with internet self-training is that without knowing the relative importance of various symptoms you can focus on the wrong things. An even bigger risk is that the people writing the articles can have excellent credentials or be total quacks or snake-oil salesmen. I check lots of things out on the internet, but I stick to reliable sources like Mayo Clinic, various University sites, and National Institutes of Health sites. I hope you do the same.
I'm concerned about your father's low readings! I suggest you look up Hypoglycemia on the May Clinic website, just as background for your visit with the endo.
Hang in there! You are doing your best, and that is all any of us can do.
Will the staff at AL do the dressing? Pretty sure a nurse has to do it, so let the staff there know - they will need a copy of the order and wound care supplies too.
Eewww- bad infection control at the foot doctor's office! I would tell the doctor about it. He should know- that can cause bad cross infections. Yuck!
You are doing a swell job, Bella. Gotta move forward - the past is the past!
The feet... Well, I'm glad that somebody's taking proper control; that gives your father the best possible chance to heal. "Best possible" may not be all that great, is the only thing. Not to depress you, just so you don't get knocked sideways if it doesn't go so well.
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