I have had type 1 diabetes for over 45 years and I have moderate calcification of the arteries in my legs and neuropathy, as well. I have an ulcer on the bottom of my left foot that is not healing. This ulcer was caused by a Charcot joint in my foot and it pierced through the skin from internally. I wear prosthetic boots since that discovery and the pain is quite severe. I presently take 1 mg of Dilaudid every four to six hours as needed. I am also on Cipro as an antibiotic for a foot infection on the surface of the ulcer. I was told by my vascular surgeon that I have a choice to make: have my leg amputated or to endure the pain and take narcotics or some other pain relief method up until I cannot stand the drugs or the pain any longer. I am not sure what to do, as I was told by a wound care specialist that if my leg were amputated, I would die within three years. I am so confused. Is there nothing else I should look at or do to prolong the life of my leg, and my life?

I am sorry you are in that position. I hope you have a physician with whom you can talk, who is empathetic, and who is in a position to counsel you more than that. First, I am not clear on what the vascular surgery options are for you. With patients who have diabetes, it is not only an involvement of large blood vessels that are occluded, but small vesselsmay also be occluded. This makes it difficult to do any further bypass procedure to get blood flow to the ischemic tissue. If there are no additional vascular surgery issues, how much rehabilitation potential do you have? Will they let you walk? Maybe walking is too painful. If you have not seen a pain specialist, you probably should. This would be especially true if you are willing to try and put up with the pain and try to preserve your leg. These pain specialists could try regional blocks and use additional medications that are not strong narcotics. Their use may have a dramatic effect on your quality of life. I would not necessarily do anything unless you have seen a pain specialist to get a handle on how much of the pain can be treated. I have worked with patients before who come to that painful decision. However, most patients know what they want by the time action plan is made.

JTL