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Hi all,

Seeking some thoughts/suggestions on caring for a patient I have not seen but have discussed with a colleague recently.

Profile:

Female, Mid-50's, Office worker but does move around a lot (estimated 6Km per) day, suffers from diabetes (managed by medication), no other significant medical history.
Most recent HBA1C 8.6%

Complains of a long standing VP on the posterior aspect of the Calc - where the TA inserts, approx 3.5 years duration. She has been self treating (with one of those razor blades attached to a handle) for a long period of time, but feels the VP is becoming too large to manage by herself. She has not used any topical treatments because of being diabetic, and her doctor has advised her to cease self caring at all because of her risk factors.
She is now at the stage where she is unable to manage a full day of work because of the position of the VP and its size. Her footwear I would describe as "sensible" flat shoes.

She is hoping to recieve some treatment to alleviate some of the discomfort even though she realises a cure is not guaranteed.

How would you manage said patient, or what would you suggest be tried?

We have considered acid's, cryo/electro-surgery, and needling, but have discounted them all in light of the risk factors with wound healing, scarring and risk to the Calc and TA.
We are considering a regular (possibly intensive) course of treatment involving Silver Nitrate (AgNO3) and scalpel debridement.

Thanks,

Duncan

 

Hi Duncan

This is my 2p worth of suggestion...
As you know there is no one effective treatment for VP.My experience would be looking at the size of the lesion.Based on the site and duration-it causes the patient discomfort and obviously impacts on her quality of life,my feeling as is yours would be to offer some form of treatment.Its difficult to choose one treatment option over another for all the reasons you mentioned....the only thing I can suggest not having seen the patient is starting on a course of multivites to boost her immune system as well as using the Ag NO3 or even perhaps a weaker chemo preparation (needs to be closely monitored) until VP reduces in size or even maybe a homeopathic treatment.I recently read an article which says that Marigold therapy is safe and has no adverse effects.I have never tried this so cant tell you based on personal experience.

Good luck

Faye

 

Hi Duncan

Furthermore with regards her Diabetes: if she has no complications and is stable;even though her HbA1C is 8.6% who is to say she wont heal.Also she has been self-treating for a long time so she must have been healing? My feeling would be to treat and then monitor her progress carefully

F

 

Alternatively you could give her an informed choice and let her decide for herself.

Dr. Strangewart or: How I Learned to Stop Worrying and Love the V.P.

Sorry, **** day.

 

Thanks both of you.

As far as I am aware she has been started on mutivits by her doctor (I will have to check to be sure), and she has decided she wants some treatment because of the pain it gives her which is affecting her life.

I think Simon has hit the nail on the head - give her the pro's and con's to each then leave the choice with her.

To borrow the English phrase "In't informed choice brilliant!"

 

Would the use of duct tape on VPs on a diabetic foot be a daft idea?
I remember a GP suggesting this for one of my sons when they were younger.

It may help.

Regards

weefeemcdee

 

Yes: Duct tape does not work for VP's