Dr. C. Elanchezhian
General Medicine
The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.
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Patient's Query
Hello doctor,
My brother has swelling on his left foot. He has a boil on his left inner leg 4 inches above his left ankle inner bone. The doctor he visited gave him medicines for his boil and said the boil will come out in some days. The swelling in his foot has increased and so he visited the same doctor the next day and was advised to see an orthopedic. The orthopedic doctor did not diagnose it but referred him to a general doctor who again did not diagnose it but said there is pus buildup inside the foot and it needs surgery. My father who accompanied my brother asked the doctor whether it will subside with medicines or if surgery is needed. The doctor simply said you can use the medicine or you can do the surgery.
I am out of the country and feel the doctor may have not specified the situation correctly to my father and also may have not clearly explained why he suggested the surgery. I needed a second opinion, as I want my brother to receive proper treatment and identify if it is a serious condition and I need to know the best solution. I also want to know why the doctor mentioned surgery for a pus buildup and what is the diagnosis of the foot condition. I can provide pictures of my brother's foot if needed.
Hello,
Welcome to icliniq.com.
He is having diabetes? If yes, what is the sugar level? If yes, first you have to control the sugar level. He is having a deep infected ulcer with cellulitis. What medications he is on?
Since it is a deep and swelling extended up to the foot better open the wound and drain pus and send it for pus culture and sensitivity. Meantime, start tablet Pan 40 (Pantoprazole) one-two times daily before food, tablet Ciprofloxacin 500 mg two times daily, tablet Combiflam (Ibuprofen) one tablet twice daily, and tablet Chymorol forte one tablet thrice times daily for five days after food, and wound dressing with T Bact ointment.
Patient's Query
Hi doctor,
Thank you doctor for your follow up reply. His earlier dispensary doctor and hospital doctor had given prescriptions which I have attached. My father had taken my brother to third hospital today and the doctors there have advised dad to bring my brother daily for the wound dressing. My brother is not diabetic. He has no fever and the swelling has reduced a bit. I am unaware if any pus culture test has been done but I will follow up on that. I have attached images of his dressing done by dad and will attach more images when I receive them. In your reply you had mentioned that if you treat early gangrene will form in leg and foot, but also mentioned better to treat early. Please advise as I was a bit confused on that part. I am pasting your reply below. Please also clarify what are his chances of getting septicemia or gangrene in the present situation. He has begun taking the medicines and also will be going daily for the foot dressing.
Hi,
Welcome back to icliniq.com.
Good. Now, the swelling has reduced with Azithromycin antibiotic. Yes, you have to take my above reply as "if not treat early, gangrene will form". I think this treatment is having good response. You can do pus culture and sensivity test to select correct antibiotic. Now I do not think he will get septicemia. Daily dressing is good and advisable. Hope, he will be fine. Take care.
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General Medicine
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