Case 41: Successful Treatment of Congestive Heart Failure, Azotemia and Heel Ulcers in Patient with Diabetes and Severe Arteriosclerotic Myocardopathy

This 78 year old diabetic man was hospitalized in New Jersey for congestive heart failure, leg edema and leg ulcers. Triple vessel coronary artery surgery had previously taken his leg veins. His left heel ulcer enlarged during the hospitalization . He was referred to a nearby nursing facility in Bryn Mawr for boot therapy. His ankle/arm index was 0.66 and 0.26 in the right and left legs respectively. His initial BUN was 93mg/dl and fell with boot therapy to 73 mg/dl. Bactrim was prescribed for his heel infection and unfortunately was associated with a rise in his BUN to 104 mg/d. The Bactrim was discontinued and his boot therapy continued and his BUN fell to 39 mg/dl. Doing well, he returned home to New Jersey and in a few weeks without boot therapy again developed congestive heart failure. He returned to our nursing facility again for boot therapy. His weight dropped from 190 pounds to 145 pounds as he diuresed. As seen in his serial pictures, his heels did well. He was ambulatory and went out for a big dinner the night before his scheduled discharge from the nursing home. After the dinner, he collapsed in the parking lot and died. His discharge pictures were never taken.

Right Heel 10/14/93

Left Heel 10/14/93

Right Heel 11/30/93

Left Heel 11/30/93

Comments: At times boot patients seem to feel perhaps too well while on therapy. This man overate. Others have gone home and attempted to dig up their gardens, for example, when they had not had such exercise in years. Moderation is obviously important. This man benefited form the cardiac-assist action of the long boots. His renal function improved. He healed his ulcers. He celebrated his good fortune, but too well.