Feb 21, 2017

Elderly woman with ulcerated foot needed amputation, after one year of treatment, wound healed

For patients suffering from diabetic foot, if the wound ulcerates, turns black, the nerves lose senses and becomes numb, Western medicine practice in general will cut out the ulcerated flesh. For severe cases, the limb will be amputated in order for patient to survive. The elderly patient of this case suffered from severe diabetes and Alzheimer’s disease. She was seventy-six when she came to me for medical treatment. She came in a wheelchair on her first visit. She was weak, pale, green, yellow and grey and lacked lust. Her gaze was dull and her response was slow. Her hospital discharge reports indicated that she had a high glycemic index and severe neurodegenerative disease. She could not recognize the family. Her left leg needed amputation from right above the knee, otherwise her condition would be life-threatening. Her left foot was swollen and the outer calf was ulcerated. Her heel was inflamed with pus. Bad flesh turned black and the affected area had no senses. The affected area had had a surgical debridement, leaving a large wound, exposing the bones. Due to gallstones in the abdomen, she underwent gallbladder removal surgery not too long ago and the abdominal wounds had not healed. The wound was often seeping blood. The back of her little toe and the instep also had small wounds. Her hands were very cold and her pulse was weak.

The patient is a Hong Kong native. Considering her old age, her family members arranged for her to stay in Jiangmen in Mainland China for her remaining years. She lived in a nursing home. After she started treatment, at the third follow-up visit, her ulcerated foot made good progress. It was gradually regaining senses. It could move and when the wound was touched, she would show a painful expression. At the heel, there was a hint of red, indicating that blood circulation was restored. Her calf was not inflamed nor excreting pus. The surface of the dead tissue was dried. The wound was wrapped in gauze but there was blood seeping out of it sometimes. I believed that her left foot had restored ‘Qi’ and blood circulation. There was no need for amputation. Her son also said that since his mother started taking the medication, she had a lot of defecation.

Wound healing, regained senses

At the fourth follow-up visit, patient came to my clinic directly from the nursing home. Her spirit was not bad, however, she lacked energy and was unwilling to talk. The swelling on her left foot had reduced. She could move her legs but without strength. When the affected area was touched, she immediately retracted her leg out of pain. Her toes were freezing cold. At the fifth follow-up visit, when I examined the wound on her foot, I found that the gauze was wrapped too tight. It would inhibit the circulation of blood. I urged them to not wrap it too tight otherwise it would affecting muscle growth. Bleeding from the wound of the calf had reduced. When I opened the gauze and touched the nerve, she would feel pain. She could turn, flex, stretch and retract her feet flexibly. Before the medication, they were immobile. The recent measurement of glycemic index had dropped by four to five points and was under control. However, her appetite was still poor. When she ate congee, she would spit the food out and only swallow the congee water. When I saw her at this visit, she did not keep her head low and not talk. She was full of energy and looked around, although she still seldom spoke. I had to ask my questions many times before she would answer in a word or two.

The wound on patient’s abdomen was a lot better already, but because soapy water flowed back during a bath, it was inflamed and the suture was exposed. The family wanted to go to the hospital to question the Western doctor about the operation but later decided not to pursue lest causing more problems. I reminded them to be especially careful with this wound. I suggested them to use hydrogen peroxide for disinfection, wrap with gauze and then with adhesive tape to prevent it from coming loose. At the seventh follow-up visit, she sat upright, her neck was strong and when I called her, she would turn and look at me. There was no major changes with the heel wounds. I suggested that her family request the nurses at the nursing home to not wash the wound for the patient. If the wound got wet again after it was dried, it made it difficult to form scab and heal. As for the calf, it was recovering well. The ulcerated flesh had slowly grown new muscles and skin and the wound area became smaller.

Facial expression reborn and lively

When patient came back for a follow-up visit after 2 weeks, she appeared in good spirit and had a smile on her face. When I asked how she was that day, she immediately responded, “well.” I asked her family how was her appetite. They said that she still ate congee, rice noodles and so on, food that was easier to swallow. Her right big toe that was wounded while cutting the nail had, fortunately, healed without any inflammation. On her left heel, there was yellowish white, light greenish viscous fluid seeping out and sometimes with blood. It was pretty scary. I felt her pulse, her heart was still weak. I told her family again to wash off the viscous gangrene and keep the wound dry in order to avoid further inflammation worsening it. Her abdominal wound healed well. Most of the scab on her calf had been shed, revealing pink newborn tender skin.

Patient went to the hospital for a follow-up. The doctor did not feel there was any improvement and insisted on amputation, otherwise she would not be bothered. I thought this Western doctor was being unreasonable. The patient’s spirit and complexion had improved so much but he failed to see. In particular, her calf muscles had already been healed. This showed how deep Western medicine’s prejudice was against Chinese medicine. Fortunately, the family members understood and did not go with the amputation. Later, I talked to the patient’s daughter-in-law. She said that her mother-in-law’s condition was much better, especially that of her dementia. She could remember her own name, communicate with other people, talk and laugh. It had only been two months since patient’s first treatment and the effect was incredibly unexpected. The family was overjoyed.

Increased appetite, able to stand up

Later on, patient returned to Jiangmen to rest. Her spirit was good. She ate more than before. She often used the chopsticks to get food and did not need to be fed. Her condition was much better than when she was in Hong Kong. Her family often sent me daily life pictures of her. In one of the pictures, she looked at the camera, holding a bowl of rice. Her gaze was bright. She was sitting like a normal person without an indication of dementia. One day, she suddenly stood up from the wheelchair and walked but accidentally hit the glass window, bruising her right eye. I told her family to take good care of her to avoid any complications. Recuperation progress of her calf was exciting. The scab was about to fall off. The heel no longer secreted green mucus, the condition improved. I reminded them that the wound needed to be kept dry after washing. The surface of the feet began to show wrinkles, indicating that the heart and kidney were strengthening. More blood flowed to the brain, so that her memory was restored, her response was faster and the swell on her feet had disappeared. When talking with her family, her response was good. She would ask and answer questions.

At the twenty-fourth follow-up visit, patient’s memory had greatly improved. Apart from being able to greet me by the name, she could remember her name and recognize her daughter-in-law and grand daughter-in-law. The ulcerated flesh on her heel was still sticking to the bones. However, there was newborn flesh growing on the side. Later on, a cyst grew at the bottom of her left foot. It was discharging pus and seeping blood. It was not healed after a long time and needed continuous squeezing out the pus. I thought the growth of the cyst was due to a new wound that had bacterial infection. At the thirty-fourth follow-up visit, her calf wound had basically all new growth of skin. The bones exposed at the heel was also wrapped in new skin, which continued to thicken. However, the cyst at the bottom of the foot had not healed. Her family thought that it was related to the wound on the heel. One time, they pulled out a piece of ulcerated flesh from the cyst. Fortunately, inflammation was not serious. At the thirty-eighth follow-up visit, the cyst was cured and got better. After more than a year of treatment, patient’s diabetic foot was almost completely cured. The swell in the left foot had also completely dissipated. The big toe had grown new nail. She could move freely at the knee joint. Her daughter-in-law had called and asked if she still needed medication. I said that patient was still in rehabilitation and it was not recommended to discontinue medication. However, if they felt it was not important, it was not a problem. It was understandable that every time patient came to Hong Kong from Jiangmen and back after staying overnight in Hong Kong, she would be so exhausted. This case was a very successful medical case. Patient not only was saved from amputation, her memory was also restored and she returned to a normal life. She was treated from May 21, 2009 to October 20, 2010, about one year and seven months and 53 visits.

By Dr. Au Sik Kee

Feb 21, 2017

Medical record number: 090521

For enquiry, email: sikkeeau@gmail.com