Posts tagged feet care

It’s Getting Complicated.

I recently wrote about Lance and the shocking discovery of symptoms with a sinister familiarity to Peripheral Neuropathy. Now that I have the ability to look at the words without feeling extreme nausea, I wanted to give everyone who commented and sent encouraging emails an update.

Firstly, I have been very cool and calm when it comes to Lance’s night time groans and discomfort. I don’t want him to latch onto the fact that I am stricken with fear. I put my Cate Blanchett hat on, and while remaining completely honest with him, I cannot show him that I’m fraught with concern.

We have been to our GP, who has an amazing rapport with Lance. I dislike speaking about Lance’s Diabetes in a negative light to anyone when Lance is present. Therefore, I asked him to tell Dr Congo about his symptoms of hot, burning feet at night.

“Well, it doesn’t matter if it’s the coldest night, it feels like there is a bushfire in my feet. Sometimes I have to look at my feet just to check that they really aren’t on fire.”

Dr Congo turned his head towards me, searching for my reaction. His reaction made me want to be sick.

“Lance, tell me, do you get pins and needles often?”

“Everyday.”

“Can you point to where you feel the bushfire the most?”

Lance grabbed his ankle, then rubbed over the top of his foot, tracing his finger over blueish veins.

He also added that he has mild tingling in his lower calf.

Dr Congo pressed his middle and index fingers together on Lance’s foot. He sat in silence, concentrating.

He then performed a reflex test on Lance’s kneecaps. Normal response noted.

Dr Congo swung around on his chair and raised his eyebrows at me.

“Well, I need you to bring Lance in to have a DIabetic Assessment with one of the registered nurses. Then, once they have gathered the information we need, I’m going to refer you to a podiatrist who specialises in Diabetes complications.”

Those last two words.

I read them, I write them. Occasionally, I’ve even said them.

But no one has ever said them with such pathos.

I have also contacted his Diabetes Educator.

“What was his last A1C?” she asked.

“7.1” I replied.

“I’d say it’s a growth spurt, Kate. Seriously, kids don’t have neuropathy problems.”

“Really?” I asked hopefully.

“Well, when was he diagnosed? 3, 4 years ago?”

“It will be 6 years on the 1st November.”

“Oh. Listen, Charles is on duty today, can you please give him a call?”

(Charles is one of four endocrinologists who work exclusively with children. Unfortunately, we have never met Charles, and he is unaware of Lance’s history.)

“Peripheral Neuropathy only occurs in older people with poor control and high AIC’s. Oh, and with type 2 diabetes.”

My jaw fell in astonishment.

AN ENDOCRINOLOGIST MAKING FOUR BLATANT GENERALISATIONS IN VIRTUALLY ONE SENTENCE.

“I’d just like to point out that before Lance started on insulin infusion, his control was shocking, he had massive fluctuations due to growth hormones. He was having up to 7 injections a day to keep him in single digits, and it was really hard work to achieve that.”

“Nup. Doesn’t make any difference. He’s type 1.”

As much as I was desperate to believe him, I was angry that he was brushing aside my concerns, and his slap-happy approach to pinning peripheral neuropathy onto lazy, irresponsible adults with type 2 diabetes left me postively livid.

Our endocrinologist is in Vietnam on a 4 week holiday. He left the day before I called him.

Lance’s Aunt Kel is a sports scientist, who is currently completing a two year trial with a group of men and women in their sixties,all who have type 2 diabetes. She is excited to present her thesis which will reveal that each of the particpants blood sugar levels have overall improved dramatically as a result of strengthening muscles through weight training.

I spoke to Kel last night, and mentioned Lance’s symptoms.

“Oh my God.” she whispered.

“I KNOW!” I exclaimed, relieved that someone understood my concerns.

She immediately launched into exercise specialist mode and set Lance 100 toe lifts (quick lift up onto toes, and slow drop on the way down) a day. She encouraged plenty of foot movement, toe wiggles, trampoline, circling his feet, all in an attempt to improve circulation. I immediately felt so much relief from hearing advice that was positive and beneficial from a professional.

So, Lance has commenced his toe lifts, we have an appointment with Dr Congo tomorrow who will write Lance’s assessment and then contact the podiatrist for an appointment.

I have incorperated a 10 minute massage after Lance’s shower. I rub until I can feel warmth exuding from his feet , and it is providing him with a little relief.

There really is nothing more that I can do, except to try to remain positive.

I will give another update after the assessment and the appointment. Looking at this has made me remind myself that Diabetes is not just about insulin therapy. As a parent who is responsible for educating my son about how to take care of his condition, I acknowledge that’s its so important to remain quietly vigilant everyday. Just little things could make a mammoth difference to a complication-free adolescence. Now that we’ve passed the five year mark, we need to add some new specialists into our diabetes management program.

As much as I do worry, I am constantly amazed at Lance’s ability to accept what accomanpanies diabetes. Right now, his biggest worry is whether he’s getting a Lego truck for his birthday.

The Birthday Present. (Well, one of them. I'm hopeless.)

The Birthday Present. (Well, one of them. I'm hopeless.)

(It’s sitting up in the top of my cupboard wrapped between pillows and blankets. He looks at a Lego catalogue everyday, and studies intently the detail and pieces of this truck. I’ll have an 8 year old in 26 days, and he’s simply amazing. :))

 

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Diabetes Productions Proudly Presents “Unhappy Feet.”

Lance’s Dad and I have a reoccuring nightmare.

It has nothing to do with his love of Sci Fi flicks, or from disecting dead redback spiders.

Our nightmare is far, far worse than anything you get to see in an art department or in a special effects trailer on location of a horror movie.

It’s real.

It could affect our son.

We see live human evidence of it almost everytime we visit the Diabetes Outpatients Ward.

Severe Diabetic Foot Ulceration (photo taken before amputation.)

(Sorry…I had to start with the worst image first to keep your interest.)

This is such an overlooked issue, yet possibly the most sinister long term side effect of Diabetes.

Peripheral Neuropathy and Amputation.

Lance’s Dad and I both have our own fears for our son as he grows into an adult living with Type 1 Diabetes.

However this is one nightmare that we both share.

You see, our Happy Little Vegemite HATES shoes. Even as a baby, we have a photo of him, on his bouncer with his foot in in mouth trying to tear off his sock. If he had his way, he would roam the streets barefoot and fancyfree.

Lance has a shoe closet that would rival a Beckham offspring. He has different styles and funky coloured Nikes, Pumas, Filas. Canvas laceups, uggs, crocs, Spiderman light-up-when-you-walk sandals, thongs….you name it..he has it.

Last year, I presented a speech at an awards presentation. There, in the front row, was Lance, struggling, red faced and on the verge of a panic attack, trying to remove his offending footwear. (“They were suffocating my feet!!”) At the very best, sandals, uggs, and thongs are still high tolerance shoes for him.

I understand where this fear of being constricted comes from.

On Diagnosis Day, whilst drifting in and out of consciousness and in the firm grip of deadly DKA, Lance had to have a drip inserted into his hand. Except they put it in on a crooked angle. So they had to do it again. (His tiny body may have been lacking in insulin, but he certainly proved that he could crank up his adrenalin!!) His little legs were pinned down to an examination table to stop him from thrashing. His arms were held down, two doctors on each side, so that they could get a blood sample from other arm. His head was even held back by two nurses, to prevent any further chaos due to his furious determination to be released. His azure blue eyes penetrated mine, his face awash with confusion. I will never recover from that look of abandon, that, despite his hysteria, was clear for all to see. His mother who had lovingly held him and protected him for his first year on Earth, had suddenly handed him over to total strangers to hurt him and take away his freedom. Little did he know that I had no choice-these people saved his life.

(These memories are so painful, I had to stop typing momentarily and snuggle up beside my son, my ear pressed to his back, random tears soaking up in his sweet smelling pyjamas. I can still put my hand in his, and he will entwine his fingers with mine, even in the midst of slumber. I will fight to set you free from this my love.)

As a result of this, Lance still has issues with being being held too tightly, seatbelts and wearing restrictive clothing. Shoes are number one on the list of “Let me OUUUUUUUUUUT!”

The point of this story is that I often find Lance outside, frolicking wildly with his dog, with his feet bare. He will agree to come inside and put some form of protective footwear on, but only when asked.

He will climb the fence, and later come hobbling inside, tearfully acknowledging the splinters that he has newly aquired from chatting to My Neigbour. Even whilst I squeeze, remove and apply alcohol wipes to the affected area, it’s STILL not enough for him to remember for next time.

Today, I was absolutely exasperated when I discovered Lance teetering on the edge of the fence again, chatting to his friends who ride by daily. Shoeless.

After his recent discovery of long term complications, I told him to follow me to the PC. I googled “foot ulcers diabetes” and clicked on images. We both remained silent as we observed the gaping, festering holes in feet, toes barely hanging on by a thread, bones visible through the erosion of skin. We looked at each other knowingly. His eyes were like saucers, his mouth was slightly agasp. He gulped, and said to me, “These are adults’ feet. Look at my feet, Mum! I don’t have any holes in them! I’m careful! I know how to be responsible!”

However after he left the room, ten minutes later, I witnessed a scene that allowed me to exhale a sigh of relief. He was sitting on the sofa, climbing into a pair of socks, and strapping on his sandals. He then proceded to go outside. I hated showing him those images…Definitely a case of being “cruel” to be kind….

“People with diabetes are at risk of developing ulcerations and infections within their feet, which have the potential to require an amputation of the foot or leg. In fact, the most common reason a person with diabetes will require hospitalisation is for a foot complication. Even trivial or minor injuries to the foot have the potential to become very serious and threaten a limb.”

Despite Lance’s disdain for shoes, he has learnt to become very aware of good feet health whilst inside the home. He will always report the tiniest graze, or removal of top layer skin so that I can treat it immediately with antiseptic and cover it. (I have learnt that it’s beneficial to make extra fuss over feet injuries, I have even resorted to bandaging an area to psychologically entice Lance into understanding that feet injuries are something to be taken seriously, and that his feet are a very important priority when it comes to his overall wellbeing.)

I have had several debates with parents of other children who have Type 1 Diabetes about introducing feet care to them at an early age. Some have agreed and considered it to be a good preventive measure, others have seen it as just another burden to take on, and that their child was “too young” to worry about a procedure such as amputation.

Two years ago, I made an appointment at a podiatrist that specialised in Diabetic complications. Soon after, Lance had his first consultation with him, as I was concerned about a toenail that had been cut by a well meaning relative. (It was a little too “close” to the edge for my liking…) He also had a thorough examination of both feet, and had his toenails cut correctly.( I asked if he could demonstrate correct nail cutting techniques step-by-step, so that I could continue doing it the same way at home.) He commended me for bringing Lance to be examined, noting that if Diabetes Educators drove home the point of commencing meticulous feet care immediately after diagnosis, that so many tragic amputations in young adults living with Diabetes could be avoided.

Our podiatrist is on our health care team list-we see him annually.

His general advice for parents with children who have Type 1 Diabetes:

Examine your childs feet daily; on top, on the sole, between the toes and on the heel. Look for any cuts, blisters, grazes, discolouring or fungal infections.

Teach your child to dry in between their toes after showering, and have appropriate protective footwear at public pools/showers to avoid adding tinea or other fungal infections to the list of diabetic complications.

It may sound pedantic, and over the top, but a general rule of “shoes outside and socks inside” is doing your child the biggest favour.

Never treat corns, callouses or severe cuts yourself-ALWAYS SEEK MEDICAL ADVICE.

Non smoker, diabetic for 25 yearDiab insuline dependent for 13 years.
Left foot partial amputn 3 m25 years, insuline dnjjjjjjjj

Diabetic ulcers are the most common foot injuries leading to lower extremity amputation. Family physicians have a pivotal role in the prevention or early diagnosis of diabetic foot complications. Management of the diabetic foot requires a thorough knowledge of the major risk factors for amputation, frequent routine evaluation and meticulous preventive maintenance.”

Visit Diabetes Australia or go to their website to investigate their advice on caring for your feet. They also have online stores in each state; Diabetes Australia Queensland (DAQ) have extensive orthotic merchandise as well as socks and feetcare products.

Looking after your child’s feet now can protect them from peripheral neuropathy in later life. Good feet care, good feetwear, and good control of glycaemic levels is helping your child to become aware that an important part of having Type 1 Diabetes means being responsible for looking after your feet.

If your child does have a serious foot injury, treat it as an Emergency. Tell the ambulance or the hospital staff immediately that your child has Type 1 Diabetes. Extra care will be taken to ensure that the best possible chance of complete healing will occur.

The current motto of the week in our house?

We love NEAT SWEET FEET. 🙂

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