Surgical therapy recommended
Dear Dr. Gott: I’m an 89-year-old female and have suffered from an open sore or ulcer about the size of a half dollar on my leg for the past nine months. It hasn’t responded to any treatment. What would you suggest?
Dear Reader: When skin receives inadequate circulation, it tends to deteriorate. First, roughness and scaliness appear, then the skin becomes red and raw. Eventually, an ulcer may form as the skin breaks down.
Such sores are called ischemic ulcers (“ischemia” means “lack of oxygen”), and they are hard to heal unless the circulation can be improved. When these ulcers form near varicose veins, surgical removal of the swollen veins may have to be considered. If the ulcers are caused by poor arterial blood flow, other forms of surgical intervention, such as balloon angioplasty, may be necessary.
In attempting to avoid surgery, many patients successfully heal the ulcers by elevating the legs when possible, using elastic supports and other circulation-enhancers, and applying antibacterial creams to the sores in order to eliminate infection.
Given your age, I suspect that you will need aggressive, surgical therapy.
Ask your doctor about this and, if he agrees, request a referral to a vascular surgeon. In the meantime, try the nonsurgical techniques that I described.
Dear Dr. Gott: I recently had blood drawn in my doctor’s office. He ultimately called to indicate everything was fine, but added that my kidneys seem to have slowed down. Since I’m 83, he felt it was to be expected. What did he find in my blood, and is there anything that can be done to correct the condition?
Dear Reader: It comes as no surprise to the elderly that things in general are slowing down; the kidneys are no exception. A decline in renal function – as measured by the blood tests called “BUN” and “creatinine” – is to be expected. Your doctor apparently believes that your diminishing kidney efficiency is age-related.
At this point, nothing particular needs to be done, unless the blood tests reveal progressive renal deterioration. In this case, further tests, such as kidney X-rays, would be indicated.
Of course, you should continue to maintain an adequate fluid intake; your doctor can suggest an appropriate amount. Remember that many medications – chiefly diuretic drugs, such as Lasix, and anti-arthritis medicines, such as Naprosyn – often cause a mild and reversible rise in the BUN and creatinine levels.
In most instances, this can be ignored.
Follow your doctor’s recommendations about proper monitoring and follow-up.
To give you related information, I am sending you a copy of my Health Report “Kidney Disorders.” Other readers who would like a copy should send a long, self-addressed, stamped envelope and $2 to Newsletter, P.O. Box 167, Wickliffe, OH 44092. Be sure to mention the title.