Chest to Toe
Our dialysis story — chapter 31
I removed Ben’s catheter bandages on Tuesday. The bottom hole is still open — not bleeding but not healed — so I put a regular bandaid on it. The upper area seems to have a blood blister. I’m not sure. It’s rather odd, but it doesn’t bother Ben. The yellow on his skin is the antiseptic that I later washed off. I’m keeping an eye on this area of his chest, and it looks better today. I’ll make sure his dialysis nurse examines it on Friday.
One step forward — two steps back.
We jump from chest to toe. I’d say it’s not related to his kidneys and dialysis, but, really, everything is related to his kidneys and dialysis.
Two weeks ago, we had appointments with our nail tech, Gabby. Me, for my fingernails and Ben for a toenail trim.
He told Gabby that the nail on his right big toe hurt. She examined it and found nothing concerning.
Your nails are pretty long. Maybe it’s just the pressure of your shoe on that nail pressing it into the nailbed and making it hurt.
He insisted that the outer side of the nail hurt as if he had an ingrown toenail. Gabby looked again.
No ingrown toenail. There’s a tiny part of your nail on the skin and maybe that’s getting pressure from your shoe. I’ll file it a bit, but it’s definitely not puncturing the skin.
She trimmed his nails and filed that little piece. He put on his shoes and said his feet felt great.
A week later, Ben told me his big toe was hurting again and asked me to make an appointment with Gabby. I was leaving for work and forgot to text her.
Two days later, as we were preparing for bed, he mentioned it again. I looked at his nail and didn’t see anything on the side where he said it hurt, but I was shocked that the nailbed was bright red and his toe was slightly swollen. I took a photo and texted it to Gabby.
She responded:
That’s an infection. He needs to see a podiatrist as soon as possible.
If my toe looked like that, I wouldn’t be too concerned. But Ben is diabetic. Infections for diabetics can rapidly escalate, causing bone infections that may result in amputation of a toe, part of the foot, all of the foot, or the leg.
Ben’s podiatrist retired during the pandemic, and we assumed Ben was assigned to one of the other doctors in the practice, but when I called Tuesday morning, I was told he would be treated as a new patient, which meant a longer wait for an appointment.
He is NOT a new patient!
When did he last see Dr. C?
I don’t know. Dr. C retired in 2020. Certainly, you still have his patient records.
Well, he would have to be a patient of one of the current doctors and he isn’t.
Why not? Why wouldn’t you assign him to someone else? Listen, his primary care doctor is Dr. F and she’s part of your medical complex. Shall I call her? I bet she can get him an appointment with someone in your office.
Dr. F has a reputation for getting things done — fast.
The woman on the phone went from being slightly annoyed to helpful.
Oh, no, that’s not necessary. Can he come tomorrow at 1:00?
Meanwhile, we visited Gabby, who again examined his toe and saw no evidence of an ingrown toenail but said:
You see those white flakes on his nail that look like dandruff? Those are actually flakes of nail. That often happens with a fungal infection.
She cleaned the nail and said to soak it in warm water and white vinegar. We did that twice before bed, and his nail looked a little better but was worse by morning.
More soaking before going to see the podiatrist, and Ben had to wear Nike slide-sandals because his toe was too swollen to fit in his shoes.
Dr. M agreed with Gabby about the nail not being ingrown.
I asked:
So, where did the infection come from?
Dr. M shrugged and said:
Something in his shoe. Moisture. Hard to say. We usually don’t discover the cause of these nailbed infections. Whatever caused it probably wouldn’t affect someone who isn’t diabetic. The fact that his circulation isn’t stellar doesn’t help, but I don’t think it’s the cause.
We treat these infections with a two-week course of an antibiotic and then re-examine. If the infection is still present, we cut away some of the nail to clean out the infection. Hopefully, we won’t have to do that. Cutting on a diabetic is always a last resort because they heal so slowly, which allows other problems to manifest.
Keep soaking in warm water and vinegar, take the antibiotic I prescribe, and come back in two weeks. But call if the toe gets worse or if the infection spreads to other toes or to his foot. Look for redness and swelling. If you see any, don’t wait until the next appointment.
She looked at his Nike slides.
I’m sure he can’t wear regular shoes, but I don’t like those slides. They’re fall risks.
I agreed and told her that they contributed to his fall last year, but that’s all he had that he could wear.
As we rose to leave, she said:
Go shoe shopping. Sandals with a strap across the ankle are better than what he’s wearing. Maybe you can find closed-toe shoes with light-weight material that will stretch a little and make room for his swollen toe.
I drove to what used to be my favorite shoe store in town. But I haven’t been there in at least two years and it was closed. Google told me the store relocated to the other side of town — the “student” side — the congested side.
Ben didn’t want to go. He didn’t want me driving through the traffic. He didn’t want to spend money on shoes “that I don’t need” and said his Nike slides were fine or he’d wear hospital socks that have treads on the bottom.
We argued.
I gave up and drove home.
I didn’t have enough energy to fight about shoes.
At home, I pulled out his old slippers. He tried them on and said they didn’t hurt his nail. I told him to wear them rather than the slides.
As I was leaving to take Syau for her evening walk, I mentioned that I’d check the mail when I got home.
As Syau and I entered the parking lot, Ben was walking from the mailboxes wearing his Nike slides.
He couldn’t explain why he changed from his slippers to his slides. He couldn’t explain why he got the mail when I said I would. He got angry because I asked those questions.
I wonder if I should just stop trying to understand what’s going on in his head. When he does something inexplicable, should I just accept it with a shrug and go about my business? These problems don’t come with instructions or a road map. I feel as though I’m driving in the dark.
The pharmacy wouldn’t call that the antibiotic was ready until well past the time I should be at work, so I didn’t work.
Ben was moody all evening. I sat on the porch and wrote — until well past dark.
He now says the slippers hurt his toe, and he’s wearing those damn Nike slides.
Maybe tomorrow will be better . . . if I can sleep tonight . . .
© Dennett 2023
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